Pine House Villa

Type of visit: Case Management - Annual Continuation

On September 3, 2026 Licensing Program Analyst (LPA) Deborah Lee conduct unannounced visit to conduct the required annual inspection, Due to technical difficulties, LPA Lee was unable to generate an electronic inspection tool and instead used a printable/PDF version. LPA Lee was met by Syndey Presleyand the purpose today’s visit was explained. The facility is licensed to serve 6 ambulatory residents ages 60 and over on the 2nd floor only. Currently, there are no residents in placement. The facility is a two-story home that consist of the following: A tour of the kitchen, dining Room, Activity/lounge area, living Room, laundry area, (3) Bedrooms all located on the 2nd floor, (2) bathrooms, storage shed for all supplies, and an outdoor shaded seating area. All bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to potential residents. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed. First aid kit was checked and fully stocked. 2 fire extinguishers fully charged, carbon monoxide detectors and smoke detectors are operational, a land line and internet service were observed. Toxins and knifes were stored and inaccessible to potential residents. There are no fire arms nor bodies of water on the premises, exits and walkways are free of debris/hazards. LPA conducted a records review of 2 staff record, 0 resident records. There is a locked centralized storage area for resident medications. Exit interview conducted, there were deficiencies cited during today's visit. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 3, 2026

Type of visit: Required - 1 Year

On 08/13/25 Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Richard Hood as the purpose of today’s visit was explained. The facility is licensed to serve 6 ambulatory residents ages 60 and over on the 2nd floor only. Liability insurance active (EXP:07/03/26), facility fees info was provided (balance $495). The facility is a two-story home that consist of the following: A tour of the kitchen, dining Room, Activity/lounge area, living Room, laundry area, (3) Bedrooms all located on the 2nd floor, (2) bathrooms, storage shed for all supplies, and an outdoor shaded seating area. All bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to potential residents. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed. First aid kit was checked and fully stocked. 2 fire extinguishers fully charged, carbon monoxide detectors and smoke detectors are operational, a land line and internet service were observed. Toxins and knifes were stored and inaccessible to potential residents. There are no fire arms nor bodies of water on the premises, exits and walkways are free of debris/hazards. LPA conducted a records review of 2 staff record, 0 resident records. There is a locked centralized storage area for resident medications. Exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 13, 2025

Type of visit: Prelicensing

On 5/22/24 Licensing Program Analyst (LPA) Alfonso Iniguez conducted a pre-licensing evaluation for an RCFE facility type. Today’s pre-licensing evaluation was conducted with authorized licensee: Richard Hood. The licensee has applied for a license to serve (6) elderly residents ages 59 and older Ambulatory only . Fire clearance granted for (6) ambulatory. A tour of the Kitchen, Dining Room, Living Room, (3) Bedrooms, (2) Bathrooms, Garage, Storage for all supplies, Back Yard with shade. The following was observed during this visit: MEDICATIONS There is a locked centralized storage area for Resident medications. PHYSICAL PLANT Facility is clean, sanitary, and in good repair. Protective devices are in place. Indoor and outdoor passageways, stairways, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68°F. degrees and 73°F. degrees. Open porches, and areas of potential hazard are well-lit. Smoke alarms operate properly. Carbon monoxide detectors operate properly. Report continues LIC 809C. BEDROOMS There is a bed for each client with a mattress, mattress pad, bedsprings, and pillow(s) which are clean and in good repair. Mattresses and pillows are flame-retardant. There is dresser and closet space for each client that includes at least two (2) drawers or eight (8) cubic feet of dresser space per client. There is a chair and lamp for each client and at least one (1) nightstand per two (2) clients. BATHROOMS There is at least one (2) toilet and washbasin per six (6) clients, family, and personnel. There is at least one (2) shower or bathtub per ten (10) clients, family, and personnel. Hot water temperature is 113° Fahrenheit. Bathroom is located near client bedrooms. There are nightlights in the hallways outside non-private bathrooms. SUPPLIES There are client personal hygiene supplies to include soap, toothpaste, toilet paper. There is a sufficient supply of clean linens to permit weekly changing or more of client top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE Dining room is near kitchen. Refrigerator(s) and freezer(s) are clean and large enough for the storage of at least two (2) days of perishable foods. Freezer is 0° Fahrenheit. Refrigerator is a maximum of 45° Fahrenheit. A seven (7) day supply of non-perishable food is present. There are enough tableware, tables, dishes, and utensils. There is enough equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. Report continues LIC 809C. RECORDS There is confidential storage of personnel records at the facility. There is confidential storage of client records at the facility. ADMINISTRATION The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES There is an outdoor activity space with a shaded area and furnished for outdoor use. There is at least one common room available to clients for visitors. MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. During this pre-licensing inspection, LPA did not find corrections are needed. LPA conducted the Component III Orientation with the Licensee and copy of this report was provided. A copy of the facility evaluation report will be available to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with their assigned CAU Analyst.the state’s words, verbatim · CDSS document, May 22, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Richard R Hood CEO/ Sydney Presley Administrator Interview Method: Telephone interview On March 19, 2024, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Mar 19, 2024