Mcnulty Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with administrator, Cherie Wood, and explained the reason for the visit. At 9:03 AM, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 9:53 AM the smoke alarms were tested and are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 5/12/2025. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for 2 ambulatory and 4 non-ambulatory, of which 1 may be bedridden. Bedroom #3 and Bedroom #4 cleared for non-ambulatory or bedridden. Hospice waiver for 4. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a gas stove, faucet, freezer, refrigerator, and microwave. LPA observe that two (2) out of four (4) gas range was only working. Deficiency will be cited in LIC 809-D. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked cabinet in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the under the kitchen sink. Bedrooms: There were five (5) bedrooms designated for residents' use and staff. Bedroom #1 and bedroom #4 are for private used. Bedroom #2 and bedroom #3 are shared. Bedroom that are in used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #5 is for staff use and was kept locked. Continue to LIC 809-C Bathrooms: There are two (2) bathroom designated for residents' and staff use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 118.4 degrees Fahrenheit for bathroom #1 located in the hallway beside room #1. LPA observe that the bathroom is missing a door knob and shower needs to be repaired due to cracks on the side. Deficiency will be cited in LIC 809-D. Bathroom #2 is for staff use located in between staff room and kitchen. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for four (4). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage attached and is used for storage and parking. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area. Laundry area and is located beside the kitchen. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records (MMR) were review for all residents for proper documentation. Resident records were reviewed for requirements and legibility: Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. Deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Apr 9, 2026

Allegation investigated: Facility staff hit resident in the face. Facility staff did not assist resident with transfers. Facility staff handled resident in a rough manner. Facility staff yelled in resident's face. Facility staff refused to provide clothing to resident. Facility staff took away resident's phone.

On 5/12/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced subsequent complaint visit to deliver final reports regarding the allegations. Upon arrival LPA met with the Caregiver Rina Bayani introduced herself by showing the department badge and explained the reason for this visit. Shortly after Administrator Wood Cherie arrived and helped with the documentations and physical walkthrough. At 12:45pm LPA requested resident and staff rosters and conducted a physical plant walk through to ensure health and safety of the residents are protected and did not observe any immediate health and safety issues. Initial visit was conducted by LPAs Perchui Milena Khurshudyan on 8/1/2024, and during the initial course of investigation, LPAs requested client and staff rosters. At 9:15am, LPA requested pertinent documentation which include, but not limited to Admission Agreement, Appraisal Needs and Services, Physician Report, Unusual Incident Reports, copy of R1's Assesment report, copy of staff training, etc. relevant to the investigation. At approximately 10:15am, LPAs conducted a physical plant tour, to ensure health and safety of the residents are protected, and the facility is in compliance the Title 22 regulations. Continue on LIC9099-C Unsubstantiated Between 11:00am – 12:00pm, LPA interviewed two (2) staff, one (1) out of four (4) residents and the Licensee. Between 12:30pm and 1:30 pm LPA interviewed two (2) nurses visiting residents at the facility. Allegation: Facility staff hit resident in the face. It was reported that Resident #1 (R1) was hit by Staff # 1(S1) on the face. Previous visit to investigate the allegation above was conducted on 8/1/2024. During the initial visit, LPA reviewed residents’ records, conducted interviews with one (1) out of six (6) residents who was verbal and able to communicate to answer questions, two (2) staff members, a nurse from Home Health, who was treating R1 at that time, and the Administrator. Information obtained through interviews with staff members and the nurse, reveal they have never witnessed or heard R1 or any other resident in care hit by S1 or any other staff members. LPA did not observe any bruises or scratches on R1’s face. Based on the information obtained, interviews and observations, this allegation is deemed Unsubstantiated at this time. Allegation: Facility staff did not assist resident with transfers. It was reported that R1 wants to visit his Church, however, staff does not assist R1 with transfers. To investigate the allegation, LPA conducted interviews with two (2) staff members, administrator, and Home Health nurse who visits and treats R1 daily. All parties interviewed revealed that R1 gets transferred from his bed to incline chair and vice versa as he/she wishes. No staff member leaves R1 on the chair for a long period of time considering R1’s health condition. R1's both legs are amputated, wears diapers, has very fragile skin and easily gets rashes, hence, staff is very careful not to leave R1 in one position to avoid skin issues. R1 was advised not to visit church during the heat wave because R1 won’t be able to seat for long period of time on the wooden uncomfortable chairs. To avoid health issues and skin wounds, R1 was suggested to wait till the weather will get a little cooler. Interview with Home Health nurse also stated that during the extreme heat weather it is not suggested for R1 to be outside or be seated on the chair for a long period of time. During the visit LPA observed that R1 had a radio and TV in his/her bedroom and was listening to religious channel. Based on the interviews, observations and information obtained LPA did not find enough evidence that staff is violating resident’s personal rights, therefore, the allegation is deemed Unsubstantiated at this time. Allegation: Facility staff handled resident in a rough manner: It was alleged that R1 was being treated by S1 in roughly manner. To investigate this complaint, LPA conducted interviews with two (2) staff members, administrator, and one witness – R1’s home health nurse who visits every day for treatment. During interviews parties denied ever heard or witnessed S1 mistreating R1 or any other resident in care in a roughly manner. Based on the interviews and observations this allegation is deemed Unsubstantiated. Allegation: Facility staff yelled in resident's face It was reported that S1 and S2 yell on R1’s face. To investigate the allegation, LPA conducted interviews with two (2) staff members, administrator, and Home Health nurse who visits and treats R1 daily insulin shots. All parties interviewed stated that no staff member yells or disrespect R1 or any of the residents in care. Administrator revealed that all employees have their training up to date and are well trained how to speak and handle residents’ in care. Interview with witness confirmed that any abuse would not stay unnoticed by her/him and would have been reported. Based on the interviews and observations this allegation is deemed Unsubstantiated. Allegation: Facility staff refused to provide clothing to resident It was alleged that S2 denies providing proper clothing to R1. To investigate this allegation, LPA conducted interviews with two (2) staff members, administrator, and Home Health nurse who visits and treats R1 daily for insulin shots. During interviews parties denied and stated that R1 does not allow anyone to turn on the AC during the hot summer weather and does not allow his/her bedroom door to stay open for air circulation. Staff does not refuse to give warm clothing to R1, but considering R1’s health issues they prevent R1 of having heat stroke by not dressing R1 with very thick clothing. LPA observed R1’s clothing dresser with proper organized clothing and noticed extra blankets next to R1’s bed. Based on the interviews and observations this allegation is deemed Unsubstantiated. Allegation: Facility staff took away resident's phone: It was alleged that S1 and S2 took away R1’s phone and did not charge the phone. To investigate this allegation, LPA conducted interviews with two (2) staff members, administrator, and Home Health nurse who visits and treats R1 daily for insulin shots. Interviews revealed that facility does not have phone restrictions and R1 always has his/her cell phone under his/her supervision. During the visit, LPA observed R1’s phone was placed on the chair by R1’s bed. Based on observations and interviews this allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, May 12, 2025 · control 31-AS-20240729132401

Type of visit: Required - 1 Year

On 5/12/25 at approximately 12:00pm an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the Caregiver Rina Bayani, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. Shortly after the Administrator, Wood Cherie arrived and helped with staff/residents’ files and medications. During today's visit, LPA conducted a physical plant walk through, at approximately 12:55pm, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22.The following was observed: The facility is a single-story home and is licensed for capacity of six (6) residents, of which four (4) may be non-ambulatory and of which fire clearance for one (1) Bedridden. Facility also has a hospice waiver for four (4) residents. There are five (5) bedrooms of which four (4) are designated for residents’ use. All bedrooms observed to be appropriately furnished and have appropriate lighting. There are two (2) bathrooms in the facility designated for residents’ and staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 1:13pm to be 136°F. Extra towels and linens were readily available in the linen closet located in the hallway. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. LPA observed facility alarms were present on all exit doors, however, the signals were off / Non-operational. SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 3:30pm they were tested and observed to be operational. The facility has one (1) fire extinguisher that was last purchased on 5/12/2025. Continue on LIC809-C KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, dish washer and sink. The kitchen appliances and fixtures were functional. LPA observed the kitchen area and found the refrigerator to be broken. LPA was informed by the Administrator that new refrigerator is purchased and will be replaced on 5/13/2025. There was sufficient stock of one-week non-perishable foods and two days of perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas observed to be cluttered and unorganized. LPA observed that sharp objects were stored inside the kitchen cabinet locked and inaccessible to residents in care. Extra emergency food was also properly stored inside the kitchen cabinets. Temperature was comfortable it was measured at 2:35pm to be 76°F. MEDICATION: LPA observed centrally stored medication is locked inside the commercial cabinets located in the dining/living room area. First Aid kit was locked inside the storage cabinet, inaccessible to residents in care and it was checked by the LPA to be complete with new manual attached to it. Facility has two (2) staff for AM shift and two (2) awake caregivers for PM shift. COMMON AREAS: LPA observed living room and a dining room that appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Facility has land line; LPA checked its operational. LAUNDRY ROOM: Laundry machines are located by the kitchen area and observed to be operational. LPA observed chemicals/detergent stored openly in the backyard, available to residents residing in the facility. LPA discussed the importance of keeping potentially dangerous items locked at all times. SURROUNDING GROUNDS: LPA observed sufficient yard space with fenced backyard. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. Exit doors were unlocked however, obstructions were observed on the exit areas. The facility does not have a swimming pool or body of water. There is a garage in the property, which is currently being used for storage. FILE REVIEW: Between 2:00pm to 3:30pm, LPA reviewed records and files of six (6) residents and four (4) staff/caregivers. A review of staff and resident records appeared to be not complete. There are no residents with prohibited conditions residing at the facility. Continue on LIC809-C An emergency exit plan/sketch along with other posting requirements are posted on the wall by the entrance area. Medications Review: At approximately 12:35pm. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. Facility also maintains Medical Administration Records (MAR). PRN medications have written orders from a physician. Potentially dangerous items are kept inaccessible to residents in care. LPA collected LIC500, LIC9020, copy of Liability Insurance Certificate. Deficiencies issued during today’s visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, May 12, 2025

Allegation investigated: Staff did not keep deceased resident's personal information confidential.

On 10/9/2024 at approximately 9:45am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced ten day initial complaint investigation visit. Upon arrival LPA met with the Administrator Cherry Wood and explained the reason for the visit. At approximately 11:30am, LPA conducted a physical plant inspection with the help of an Administrator to assure the health and safety of the residents in care. During today's visit, LPA obtained copies of pertinent documents, collected staff and residents' rosters, interviewed Administrator from 10:15am to 11:15am to discuss the allegation. It was reported that facility staff members trashed residents' personal belongings which include clothes and medical reports in front of the facility visible and accessible to people in the neighborhood. During the interview, the administrator stated that they decided to clean and organize the storage where they keep very old records from 2016 and residents’ clothes that were never picked up by the relatives. Continue on LIC9099-C Substantiated Administrator also stated that she follows the Title 22 regulations and knows that staff is responsible to hold all the records for three (3) years, however, these old boxes of records from 2016 were never shredded. The Administrator also admitted to LPA that they made a mistake and were not supposed to leave confidential records outside visible to others. LPA informed the administrator that per Title 22 regulations he/she is violating the residents’ personal rights by exposing residents' personal and confidential records to the public. Based on the interview and information provided during the course of the investigation, the allegation is deemed Substantiated at this time. Pursuant to Title 22 Division 6 under CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D), appeal rights discussed. Exit interview conducted and copy of report issued and delivered to the Administrator.the state’s words, verbatim · CDSS document, Oct 9, 2024 · control 31-AS-20241007093121

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(2) · Plan of correction due date: Oct 11, 2024

87468.2 Additional Personal Rights...(a)In addition to the rights listed in Section 87468.1...(2)To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement is not met as evidenced by: Based on the observation and interviews the administrator violated residents personal rights by exposing residents' personal and confidential records to the public which poses immediate Health, Safety or Personal Rights risks to person in care.the state’s words, verbatim · CDSS document, Oct 9, 2024

Plan of correction: The Administrator and staff will conduct training on Personal Rights of Residents and will provide copy of the training materials to RO/LPA by the POC due date, which is 10/11/24.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff and explained the reason for the visit. LPA was informed that Administrator Cherie Wood could not attend the annual due to traveling. LPA contacted the Licensee to attend the annual inspection. LPA was informed that the facility doesn't have an administrator designee. At approximately 10:00 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are interconnected and battery-operated. There is a carbon monoxide detector that functions properly installed in the living room. The fire extinguisher is charged and located in the kitchen. Kitchen: The kitchen appliances and fixtures were functional. LPA observed clutter on the breakfast table and a bottle of insect killer on the floor. LPA found an insufficient amount of perishable and non-perishable food at the facility; sharp objects were stored in an unlocked drawer in the kitchen. LPA observed a bottle of a cleaning solution under the kitchen sink unlocked. LPA observed flies in the kitchen and the kitchen fridge was unclean with spoiled fruits, vegetables, and leftover food. The laundry area is located through the kitchen. LPA observed that all laundry detergents were unlocked. Bedrooms: The facility has five (5) bedrooms. Four (4) bedrooms are designated for residents' use and one (1) bedroom is designated for staff. All four bedrooms, in use by residents, were properly furnished with appropriate bedding and linens with sufficient lighting. Bathrooms: There is one (1) bathroom designated for residents' use. The bathroom was properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 110.3 degrees Fahrenheit. No cleaning supplies or hazardous items were present in the bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. Properly labeled medications were locked in one of the living area cabinets. Surrounding Grounds: LPA observed that outdoor area is cluttered. LPA observed old mattresses, wheelchairs, hospital beds, dining table, and electric saw. LPA also observed that both emergency exits were locked. There was furniture appropriate for outdoor, however, LPA was informed that residents don't go outside. (Continue 9099C) Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. LPA observed that Resident#3(R3) is missing the physician's report LIC 602. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. LPA observed that Staff#1(S1) and Staff#2(S2) files are missing LIC 501,508 and no first-aid certificate. Licensee and Administrator files are also incomplete. Medications: Medication and Medication Records were reviewed for proper documentation. LPA was unable to conduct a medication audit. Medication Records were incomplete. Temperature: The facility maintains a comfortable temperature of 77 degrees Fahrenheit. Exit interview conducted, citations issued, appeal rights given and a copy of this report delivered.the state’s words, verbatim · CDSS document, Jul 29, 2024