Et Woodville Manor

Type of visit: Case Management - Deficiencies

On 08/17/2026, Licensing Program Analyst (LPA) Yolanda Delgado conducted an unannounced Case Management visit to assess the facility for potential health and safety concerns. LPA met with Karolien Dipodomi-Oley, and explained the purpose of the visit. During the course of the visit, LPA toured the facility, interviewed staff. LPA also observed residents being assisted with meals and assistance in getting out of bed, watching TV. There are working utilities and food supply. No immediate health and safety concerns were observed during today's visit. There were two (2) deficiencies that were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted with Joseline Myers and a copy of this report, LIC809-D, Appeal rights was reviewed and provided.the state’s words, verbatim · CDSS document, Aug 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87355(e) · Plan of correction due date: Aug 18, 2026

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: This requirement was not met as evidenced by: with the above regulation with at least two staff (S1, S2) a criminal record clearance or exemption. This requirement was not met as evidenced by: Based on observation and interviews, the Licensee did not comply . LPA Delgado learned that S1 is not associated and S2 is pending to the facility and has a current registered Home Care Organization certificate. This is an immediate safety risk to all residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Licensee agrees to associate S1 and S2 is to be supervised in order to continue to have S1 and S2 work or at the facility. Licensee to provide LPA Delgado with proof of association by 5pm on the due date indicated.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Aug 21, 2026

Administrator - Qualifications and Duties: (a)(a) The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. Administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section…This requirement is not met as evidenced by: based on LPA’s interview with Administrator and observation of documentation, Administrator is on the schedule for Mondays 7AM-7PM, Administrator was not observed at the facility during LPA Delgado’s visit, Administrator would not be able to come to the facility until 5PM and this poses an immediate, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Licensee will update, submit a current LIC500, training on Administrator duties to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry by Edelmira Serrano. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Administrator arrived during the beginning of the inspection. Resident record review began- Three (3) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Employee records review began- Three (3) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance-1 not cleared, personnel/job application, health screening and TB test results, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification expired 2/2/2027. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 145.0 degrees F-No warning labels posted. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. (Continued on next page) (Continued from Page 1) Food Service- Food supply meets the requirement of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation, and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 3/2/2026. The facility is conducting emergency disaster drills quarterly. The last disaster drill was conducted on 01/1/2026. Corporation or LLC is not active-Suspended and Annual Fees are not current. Based on the information received during this visit today, there are six (6) deficiencies with Civil Penalties issued for $500 are being cited per Title 22, Division 6 of The California Code of Regulations. This report, LIC809D, LIC421BG and Appeal Rights was reviewed with Kristine Mangente and a copy was provided at the time of the exit interview. *LPA was away from the facility from 12:25-1:25 PM The following document has been requested and is due by 3/20/2026: Staff work schedule from 3/16/2026-3/27/2026the state’s words, verbatim · CDSS document, Mar 19, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Six (6) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Employee records review began- Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification expired 2/2/2025 and was renewed and shows pending on website. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is not sufficient for safety and comfort. Water temperature measured 115.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. (Continued on next page) (Continued from Page 1) Food Service- Food supply meets the requirement of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation, and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 02/27/2025. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 02/4/2025. Based on the information received during this visit today, there are two (2) deficiency is being cited per Title 22, Division 6 of The California Code of Regulations. This report, LIC809D, Appeal Rights was reviewed with Kristine Mangente, and a copy was provided at the time of the exit interview. LPA has requested updates to the following documents to be submitted to the CCL by 04/1/2025: LIC 308.the state’s words, verbatim · CDSS document, Mar 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit . LPA was granted entry and met with Administrator Kristine Mangente, who was informed of the purpose of the visit. At the time of the visit there was three (3) staff and six (6) residents present. The facility is licensed for six (6) non-ambulatory residents, of which two (2) may be bedridden. The facility has a hospice waiver for six (6) residents. A dementia program is also on file. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for residents. LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. Facility contained PPE equipment and cleaning supplies to do regular cleaning of the facility. Cleaning supplies and detergents were locked and inaccessible to residents. The sharp and dangerous objects was locked and inaccessible to residents. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The smoke detector and carbon monoxide was operational, and the hot water temperature was recorded at 108 degree F, which met department requirements. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed three (3) staff files and training. All staff have the required personnel records on file and criminal record clearance and updated training along with CPR/First Aid Certification. Six (6) resident files were reviewed, and possessed all required paperwork that included Admissions Agreement, Physicians Report, and Needs and Service Plan. The listed administrator possesses a current administrator's certificate. LPA observed the centrally stored medication cabinet to be unlocked and accessible to residents in care. A deficiency cited under Title 22 Regulation 87465(h)(2) Incidental Medical and Dental will be issued along with a plan of correction. LPA reviewed medications for six (6) residents and found medication listed on MARs was found to be in place. LPA reviewed the facility's emergency and disaster plan. A technical assistance (TA) will be issued under Healthy and Safety Code 1569.695(c) due to quarterly fire drill required to be conducted by the end of the March 2024. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the garage and first aid kit with all required items. Fire extinguishers were fully charged and inspected. An exit interview was conducted where a copy of this report, LIC 809-D, and appeal rights was provided to Mangente.the state’s words, verbatim · CDSS document, Mar 11, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.