Whittier Cottage II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced annual visit today. LPA met with James Trazo, Administrator, and the reason for the visit was explained. Lead Administrator, Vilma Trazo-Bohanan, arrived thereafter and continued to facilitate the visit. The facility is licensed to serve (6) non-ambulatory adults age 60 and over; Hospice waiver approved for (6). There are currently (3) residents living in the home. The facility is operating within the scope of its license. The home is in a residential area of Whittier. The home consists of living room, dining area, den, kitchen, (3) resident bedrooms, (2) full bathrooms, attached garage with laundry area, front and backyard with a shaded patio area. The following was observed during today’s visit: The walkways, hallways and exits inside the home are free of debris of obstruction; however, broken bed frames, cleaning tools like mop bucket and broken trashcans were observed obstructing the outdoor walkway on the side of the house. Furniture throughout the facility was observed in good repair. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Resident bedroom #1 and garage have stored oxygen tanks, but signage was not posted in both areas in which they are kept. Bathrooms were inspected and observed clean and sanitary. Bathrooms have safety grab bars, anti-slip mats and surfaces and bathing assistive devices. The water temperature was tested in the bathrooms, but measured above the compliance range of 105 – 120 degrees F. Water temperature in bathroom #1 was 129.7- and 125.5-degrees F. during visit. Laundry appliances observed to be working properly, and detergents are kept locked. ***Continues on LIC 809-C*** Kitchen appliances were observed operational. The home has sufficient 2-day perishable and 7-day non-perishable food supply. LPA inspected the inside of the kitchen cabinets and observed roach droppings and food particles like grease and crumbs on the shelves above and below the sink. LPA also observed live and dead roaches on the kitchen counter by the sink in the top and bottom kitchen cabinets inside the shelf area. Also observed were several roach traps underneath the kitchen sink and on the counter by the kitchen faucet. Two resident insulin pens and lancets were observed in a Zip-Loc bag on the refrigerator door shelf. The front and backyard are kept clean, and a shaded patio area is available for residents. Garden is well maintained and there are no pools or other bodies of water. The garage is kept free of clutter and kept locked. Overflow refrigerator was observed in the garage and was working properly. The home is equipped with one fire extinguisher and was observed charged and operational. The facility has an emergency disaster plan in place and safety drills are conducted monthly. Last drill was conducted on 6/3/2026. Emergency supplies and extra incontinence care items are kept stored in the garage and are readily available for use. Five (5) staff files were reviewed. According to record review and staff interview, S4 and S5 do not have a Health Screening/TB clearance. Administrator indicated that S4 was hired on 6/15/2026 and S5 was hired on 6/26/2026. Administrator further indicated that both S4 and S5 have not completed a medical assessment yet. S4 and S5 do not have proof of training in their file. Administrator indicated that S4 and S5 have not completed their job training orientation nor Dementia training since their initial hiring, which is 6/15/2026 for S4 and 6/26/2026 for S5. Four (4) resident files were also reviewed. During record review, LPA did not observe an LIC 601/Identification and Emergency Information in R1's file. Staff indicated that they do not have it. The whereabouts of the form are unknown. R3 does not have a current medical assessment in place (Physician's Report). Last assessment was conducted on 6/27/2023. Medication and documentation review was conducted for (4) residents. R2’s Quatiapine Fumarate 25 mg tablet, evening dose, was not given to resident on June 29, 2026. Medication observed in the bubble pack during inspection. Administrator stated that the facility uses Medication Administration Log (MAR) for resident medication management; however, R1 did not have a July 2026 MAR log in place. LPA observed Administrator take out a blank MAR log from a binder and then proceeded to fill in the July 1 and July 2, 2026 a.m. medication administration for R1’s Metformin tablets. Also, per administrator interview, R2 refused to take their Quatiapine Fumarate 25 mg tablet, evening dose on 6/26/2026, but did not document it correctly on R2's June MAR log. MAR June 26, 2026 evening dose was signed by staff as administered. Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies are noted and citations are issued. A Technical Violation note was also created. Exit interview was held with Vilma Trazo, Administrator, and a copy of the report, LIC 809-D (9) and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Jul 3, 2026

The state marks this report as 13 pages; the online copy we transcribed has 12. You can request the full file from the county licensing office.

Allegation investigated: Staff hit resident. Staff speak to resident in an inappropriate manner.

Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent unannounced complaint visit to deliver finding to the above-mentioned allegations. LPA met with Elizabeth Pangan. Administrator Trazo Bohanan Vilma arrived shortly after. LPA explained the reason for the visit. The investigation consisted of the following: On 12/01/25 LPA Nune Margaryan obtained copies of Staff & Residents rosters, interviewed Administrator, Staff 2 (S2) and Staff 3 (S3), Resident 1 (R1) - Resident 3 (R3), Family Member 1 (FM1) and Family Member 2 (FM2). LPA requested and reviewed R1's file. Documents related to R1 were collected. LPA was unable to interview S1. S1 is no longer working at the facility. Continue 9099C Unsubstantiated The investigation revealed the following: Allegations: Staff hit resident and Staff speak to resident in an inappropriate manner. It was alleged that staff hit the resident arm (There were no visible signs of abuse on resident’s arm/hand) and staff tell resident “Shut up”. Interviewed Administrator and staff denied the allegations. They stated that they didn’t speak to R1 or other residents in an inappropriate manner telling them “Shut up”. They stated that they didn’t hit R1 or other residents. Interviewed Administrator and staff stated that the person who speaks inappropriately to residents and staff is R1. Interviewed Administrator and staff stated R1 is the one who curses and pushes staff. Interviewed FM1 and FM2 stated that staff is nice. They mentioned that R1 has a difficult personality and often make stories that never happened. They stated that R1 didn’t complaints that staff hit them. They didn’t see any marks or bruises on R1. Interviews with 3 residents indicated they have not been hit by staff. Interviewed R2 and R3 stated that facility staff didn’t speak in an inappropriate manner, and they didn’t hear that any staff tell R1 “Shut up” or hit R1. Interviews with staff, residents and FMs do not corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview conducted. A copy of this report was provided. The investigation revealed the following: Allegation: Uncleared staff caring and supervising resident. It was alleged that unclear individual work at the facility and facility has allowed S1 to provide care and supervision to clients without obtaining the required fingerprint clearance. During interview with Administrator was confirmed that S1 worked at the facility without fingerprint clearance. Administrator admitted that S1 was hired in October 2025 and has worked 3 days: 2 days in October 2025 and 1 day in November 2025. Administrator stated that S1 was not able provide fingerprint clearance and 11/16/25 was S1’s last day at the facility. LPA verified with the Regional Office telephonically that S1 does not have fingerprint clearance. Facility Personnel Report Summary did not list S1 on the report as an individual with clearance. The preponderance of evidence standard has been met; therefore the above allegation is found to be Substantiated. A deficiency is issued on the LIC9099D. Immediate civil penalty of $300 issued. An exit interview was conducted. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 12, 2025 · control 28-AS-20251123184432

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Dec 12, 2025

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 or... This evidence was not met as required. During interview with Administrator was confirmed that S1 worked at the facility 3 days without fingerprint clearance.the state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: Licensee / Administrator shall make sure all staff are fingerprinted and associated prior to working in a facility. Per Administrator Staff 1 is no longer working in the facility. Immediated $300 civll Penalty issued

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit for the purpose of conducting the required annual inspection. On today's visit LPA met with Staff Elizabeth Pangan. Administrator's Vilma Bohanan and James Trazo arrived shortly thereafter and LPA explained the reason for the visit. The facility currently has 3 clients in care. The facility is a single-story building in a residential area, with a kitchen, dining room, living rooms, 3 client bedrooms, 2 bathrooms, backyard with shaded area and attached garage. Fire extinguisher observed in kitchen fully charged. There are smoke detectors/ Carbon monoxide located throughout the facility, tested and operational. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today. LPA, toured the facility inside and out, reviewed food supply, reviewed staff and client files. Bedrooms have the required furniture including bedframes, dressers, lamps, and chairs. Beds have the required linen and the linen is in good condition. Passageways and exits are free of obstruction. LPA toured the kitchen and observed 7 days of perishables and 2 days nonperishable. The front and backyard are well maintained. The resident bathrooms are clean, and showers have non-skid materials. The hot water temperature measured at between 105 and 120 degrees F. There is sufficient lighting throughout the facility. Infection control signs were observed throughout the facility. Medications reviewed for all clients and appears to be given as prescribed. Last emergency disaster drill was conducted on 5/8/25. Interviews were conducted with 3 staff and 3 Residents. 3 staff files were reviewed and 3 client files were reviewed. No deficiencies cited during today's visit. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Wong and Nurse Consultant Olive Divranos conducted the Unannounced required annual inspection. LPA arrived unannounced and met with caregiver Elizabeth Panyan and shortly after the Administrator James Trazo arrived and assisted with the visit. The purpose for the visit was explained. The facility is licensed range 60 and over, approved for 6 non-ambulatory and approved hospice waiver for 6. Currently, the facility has 3 hospice waiver residents and 0 home health residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. Staff are cleaning and disinfecting once a day and more often for high touched surfaces. Facility has sufficient PPE supplies and has an Infection Control Plan in place. All staff have the health screening and chest x ray result in file. 2. Operational Requirement: The current plan of operation is completed. A fire clearance approved for 6 NON-AMBULATORY. LPA currently has three residents in the facility and all 3 residents are non-ambulatory. LPA obtained the updated copy of facility Liability Insurance in the amount of at least ($1,000,000) per occurrence and total amount of aggregate ($3,000,000) is in place. 3. Physical Plant and Environmental Safety: The facility is a single story house and located in the residential neighborhood area. The facility includes: living room, dining area, kitchen/laundry area, TV room, three residents bedrooms and two bathrooms and attached garage. Each residents bedrooms have two beds, drawers, required furniture and beddings and sufficient lighting and closet space. The residents bathrooms are clean, sanitary and in a good working condition. The hot water temperature in both bathrooms were tested between 105 and 112.8 degrees F which is within the title 22 regulation. Each bathroom has the required grab bar and non-skid mat. All the cleaning supplies and chemicals are stored and locked in the cabinet next to the laundry area. LPA inspected the carbon monoxide detectors and it's mounted on the wall near the laundry area and it's working properly. Each residents rooms has a working smoke detectors. The passageway, walkway and patio are free of obstruction. 4. Staffing: The facility has sufficient staffing in the facility. All staff has the updated First Aid and CPR certificate. 5. Personnel Records-Training: All the staff in the facility are over 18 years old and fingerprint cleared. The administrator is Vilma Trazo Bohanan and her administrator certificate expired on 11/23/23 but currently it's pending in the CCL system and has the required training hours. LPA review two staff files and they have the required documents included employee application, required training hour and first aid certificate and CPR certificate. 6. Resident Right-Information: The facility has the required poster include Long Term Care Ombusman, Licensing Poster and Resident's Personal Right. The residents also have internet service for at least one internet access device for residents to communicate with their family members or physician. 7. Planned Activity: The facility has sufficient space to accommodate indoor and outdoor activity for residents. 8. Food Service: Currently there's no resident is on any modified diet that prescribed by the doctor. The facility has sufficient food supply for two days perishable and seven days non-perishable in the facility. All the food in the facility are stored properly. LPA did the kitchen tour and all the appliances are working properly. All the sharp knives and utensils are stored and locked in the kitchen drawer. 9. Incidental Medical and Dental: The facility would assist residents for medical and dental care appointments if needed. All the residents' medication are centrally stored in the cabinet in the TV room and LPA inspected all three (3) residents medication and they are updated and accurate and they have 30 days supply of medication. 10. Residents Record-Incident Reports: LPA inspected 3 resident files and they all have the required documents in file which include: Identification and Emergency Information, admission agreement, and TB test result, medical consent and medication record. LPA reviewed R1-R3 has the empty pre-admission appraisal and R1 does not have any updated physician report and needs and service plan. 11. Disaster Preparedness: The facility has an updated Emergency Disaster Plan (LIC610E) and the facility has two appropriate shelter location. The last fire/disaster drill was conducted on 6/6/24. Records of resident Appraisal and Needs services plans are part of Emergency training. 12. Residents with Special Health Needs: Three (3) residents are receiving hospice services. No resident on Home Health. No resident in the facility is on any postural support. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions. LPA observed bed rail in the facility and physician order is in file. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator James Trazo A copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Jul 29, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.