Care Vanna

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Care Vanna. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 4 residents and the facility currently has no residents on hospice. Administrator Adriel Pao has an administrator certificate valid until 07/19/2028. LPA Lyman along with Caregiver Dulce Bukid toured the facility at 8:57 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. Facility appears to be clean, safe, and sanitary. The home consists of four resident bedrooms, 1 common restroom, 1 resident restroom, one staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with half rails. Resident restrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 110.4 and 114.4 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the elements including thermometer, tweezers and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and carbon monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. LPA observed a stand alone bungalow in the backyard for staff and storage. Exit gate is unlocked and operational. LPA observed ample emergency food supply. LPA reviewed the emergency disaster and infection control plans during the visit. CONT ON LIC809-C DATED 09/22/2026 Facility provided documentation of last fire drill conducted on 09/10/2026 and drills are conducted quarterly. Facility provides activities in the form of exercise and outings in the community. LPA reviewed six resident files and three staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Two out of three residents with bed rails do not have a physician order for bed rails in the file. Staff files reviewed contained required documentation as well as CPR training, criminal record clearance and required annual training. Two out of three staff do not have a health screen in the file. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. LPA observed Resident 1 has parameter medication for blood pressure and non-licensed staff are administering the medication. Facility does not document PRN medication administration nor audit medications. Based on the observations made during today's visit, deficiencies are being cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview conducted and a copy of this report along with appeal rights were given at time of visit.the state’s words, verbatim · CDSS document, Sep 22, 2026

Type of visit: POC

On September 23, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced Plan Of Correction visit to the facility. LPA is following up on deficiencies cited during the annual inspection on September 12, 2025. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. On today's visit, LPA tested the hot water temperature in the two resident bathrooms. The hot water temperature measured between 107 to 115 degrees Fahrenheit. The hot water temperature is within regulatory requirements. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. The previous citation issued during the annual visit were cleared at time of visit. An exit interview was conducted with an authorized facility representative and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 23, 2025

Type of visit: Required - 1 Year

On September 12, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Adriel Pao was notified via telephone and later arrived to assist with the inspection LPA observed that Adriel Pao has a valid Administrator certificate which expires on July 19, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for four. The facility is a single story home with five resident bedrooms, one staff bedroom, three bathrooms, two of which are for residents, a living room, a dining room, a kitchen, a laundry room, and an attached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed five resident in care and three care giving staff present. LPA observed residents eating breakfast in the dining room. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all five resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 129 and 130.2 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care. LPA observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed a fire extinguisher to be mounted on the wall in the kitchen and it was observed to be charged and serviced as of July 17, 2025. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on September 3, 2025. LPA observed the centrally stored medication to be kept in a locked cabinet located in the kitchen. LPA observed the facility has a First Aid Kit stored in the kitchen and it has all the required components. LPA inspected the laundry room and observed it to be free of hazards. LPA observed chemicals and toxins to be stored in a locked cabinets in the laundry room. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the AD, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gate of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all five resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication records. LPA observed the facility was providing over the counter medications without a prescription to Resident #1 (R1), Resident #2 (R2), Resident #4 (R4), and Resident #5 (R5). LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D. An exit interview was conducted with Administrator Adriel Pao. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Sep 12, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Francisco Piedad. House Manager (HM) Rio Marie Boecking arrived at 1:20 p.m and LPA explained the purpose of the inspection. During the inspection, LPA and Staff Piedad conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with five resident bedrooms, one staff bedroom, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 126.5 degrees Fahrenheit in two of two resident bathrooms. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service tag dated July 19, 2024. Electric stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication cabinet was observed to be locked; however, medication is being pre-poured into a plastic weekly medication organizer for each resident; a Deficiency was cited on this date. LPA reviewed six of six resident files and three staff files. Five of six resident files did not have an appraisal dated or signed in the last twelve months; a Deficiency was cited on today’s date. (Cont. LIC809-C) Staff files did not contain any documentation for staff training conducted in the past year; a Deficiency was cited on today’s date. LPA interviewed four residents and two staff. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Sep 24, 2024

Allegation investigated: Staff verbally abuse residents. Staff throws food at residents.

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analysts (LPAs) Claudia Gutierrez and Michael Tea regarding the allegations mentioned above. LPA met with Staff Rio Marie Boecking and explained the purpose of the inspection. Interviews were conducted with three facility staff, three residents, and Witness 1 (W1) regarding the allegation, staff verbally abuse residents. Per Reporting Party (RP), verbal abuse consists of shouting and bullying residents into leaving for another home. Three out of three staff interviewed denied personally shouting or bullying any resident and denied having knowledge of any other facility staff shouting or bullying residents. Two out of three residents interviewed were unable to confirm or deny if staff shout or bully them. One out of three residents interviewed denied staff shout or bully them or any other residents into leaving for another home. During their interview, W1 stated they visit the facility on a daily basis and denied witnessing staff shouting or bullying residents. (Cont. LIC9099-C) Unsubstantiated Interviews were conducted with three facility staff, three residents, and Witness 1 (W1) regarding the allegation, staff throw food at residents. Three out of three staff interviewed denied personally throwing food at any resident and denied having knowledge of any other facility staff throwing food at residents. Two out of three residents interviewed were unable to confirm or deny if staff throw food at them. One out of three residents interviewed denied staff throw food at them or any other residents. During their interview, W1 denied witnessing or having knowledge of staff throwing food at residents and stated they “have not seen any mistreatment” of a facility resident. Due to allegations being uncorroborated during interviews conducted, LPA is unable to determine if staff are verbally abuse residents or if staff throw food at residents. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, May 23, 2024 · control 22-AS-20240514131824

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Claudia Gutierrez and Michael Tea are conducting this unannounced case management inspection, in conjunction to Complaint Control #: 22-AS-20240514131824, for the purpose of citing deficiencies. During today's visit, LPAs conducted a tour of the facility and observed a detached storage building being used as a bedroom for Resident 1 (R1). LPAs also conducted a resident file review, and per Physician Report dated May 1, 2024, Resident 2 (R2) is currently bedridden. The facility is currently licensed for six non-ambulatory residents. Based on today's observation, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Immediate civil penalties are also being assessed. See the attached LIC421IM. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, May 23, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a)(2)(B) · Plan of correction due date: May 24, 2024

No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building. This requirement is not met as evidence by: LPAs observed a detached storage building being used as a sleeping room for a resident, which poses an immiedate safety and personal rights risks to person in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: AD stated the resident would no longer be using the detached building as a bedroom and would return to their assigned bedroom inside the home immediately. AD will provide LPA with picture proof via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87202(a)(2) · Plan of correction due date: May 24, 2024

Fire Clearance (a) ... Prior to accepting or retaining any of the following types of persons,... licensee shall notify the licensing agency and obtain an appropriate fire clearance approved..(2) Bedridden persons This requirement is not met as evidence by: The facility is licensed for 6 non-ambulatory residents and one out of five current facility residents is bedridden, which poses an immediately safety risk to persons in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: AD stated they will submit an LIC200, $25 check, and facility sketch to the regional office in person or by mail and proof will be provided to LPA via email by POC date.