RC Premier Villa 1

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to the facility on today's date for the purpose of delivering an Order to Licensee/Facility of Immediate Exclusion From Facility forstaff (S1). LPA initially met with Alfred Flores, who contacted MJ Cabrera, House Manager. LPA spoke to the House Manager, by phone, who indicated he would arrive shortly. Also present was care staff, Apolinario Macaraeg. LPA met with MJ Cabrera, House Manager, at 3:30 pm and explained the purpose of today's inspection. LPA provided the House Manager with a copy of the Order To Licensee/Facility of Immediate Exclusion From Facility regarding staff (S1). The House Manager stated that (S1) has not worked at, or resided at the facility since on/around April 23, 2025. House manager indicated he understands the requirements as stated in the Order served today. There are no deficiencies issued in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 28, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete a required annual Inspection that was started on December 2, 2025. LPA met with Zadel Cabrera, Administrator, and MJ Cabrera, House Manager. Also present were staff, Faye Villaroman, Anita Macareg, and Angela Umagat. LPA observed (2) residents in the common area and (4) were resting in their rooms. The facility is licensed for (6) non-ambulatory residents and has an approved hospice waiver for (2). Currently there are no residents under hospice care During today's inspection, LPA and the House Manager reviewed medications for (2) residents. Orders matched medications and documentation was current. The facility uses a Medication Administration Record (MAR). Staff to receive refresher training on immediately initially the MAR following the medication being administered. LPA and the Administrator discussed multiple regulation updates made earlier in 2025, and LPA observed an updated Dementia Care Plan is on file. LPA obtained updated contact information. SOC341 was discussed and a staff refresher training will be conducted. There are no deficiencies issues in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Dec 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an annual inspection and met with MJ Cabrera, House Manager, who contacted the Administrator, Zadel Cabrera, who arrived at 3:45 pm. Also present was staff, Faye Villaroman and Alfred Flores. LPA observed (5) residents in the common area and (1) resident in their room at the start of the inspection. LPA and the Administrator toured the interior and exterior of the facility, including the common areas, resident bedrooms, staff rooms, bathrooms, kitchen, laundry and patio. The facility was observed to be clean, in good repair and have sufficient furniture and lighting throughout. Resident bathrooms have grab bars and non-skid flooring, and there are (20) second hand-washing posters by each sink. There is sufficient 2+day perishable and 7+day non-perishable supply of food. The hot water measured 111*F in the kitchen and the inside temperature measured 73*F. There is an additional refrigerator with a locked box for medications. Sharps are locked in the kitchen and toxins are locked in a separate cabinet in the common area. Sharps are locked in the kitchen and toxins are locked in a separate cabinet in the common area. All doors have working alarms, and the fire extinguisher was last serviced 7/7/25. There are sufficient blankets, linens and PPE supplies on hand. Residents use a necklace pendant to call for assistance. There is one unlocked exit. LPA did not observe any obstructions to the doors. Staff are aware where the utility shut off valves are. LPA reviewed (2) resident files and (2) staff files. Files were organized and contained current documents. LPA will return soon to complete the annual inspection and will review medications, discuss topics on the Care Tool and interview staff and residents. There are deficiencies issues in this report. Exit interview. Copy of report emailed following this inspection.the state’s words, verbatim · CDSS document, Dec 2, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sabrina Calzada conducted a scheduled Pre-Licensing Inspection on 10/2/24 (10:00 am). LPA met with Zadel Cabrera, Administrator. Also present was caregiver, Karmen Szilvassy. LPA observed (2) residents sitting in the common area and (2) residents resting in their rooms. Administrator for the current license, Marikar King, was also present. Later during the inspection, members for the pending license, Juvy Bartolome and Angeline Lardizabal, arrived and participated in the inspection. The reason for the pre-licensing is due to a change in ownership. The facility is currently licensed for (6) non-ambulatory residents, (2) of whom are approved for hospice. Currently there are no hospice residents. LPA and others toured the interior and exterior of the facility, including the common areas, resident bedrooms, staff rooms, bathrooms, kitchen, laundry and patio. The facility was observed to be clean, in good repair and have sufficient furniture and lighting throughout. Resident bathrooms have grab bars and non-skid flooring, and there are (20) second hand-washing posters by each sink. There is sufficient 2+day perishable and 7+day non-perishable supply of food. The hot water measured 116*F in the kitchen and the inside temperature measured 77*F. There is an additional refrigerator with a locked box for medications. Sharps are locked in the kitchen and toxins are locked in a separate cabinet in the common area. All doors have working alarms, and the fire extinguisher was last serviced 7/25/24. The smoke/monoxide alarms are working, and the fire door automatically closed when the alarms were tested. There are blankets/linens/PPE supplies on hand. Residents use a necklace pendant to call for assistance. There is one unlocked exit. All required postings are posted in the common area. Inside temperature measured 77*F. Resident and staff binders are organized and complete. Comp III was conducted during today's inspection. Pre-licensing is complete and this facility has no deficiencies. LPA to notify analyst in application unit. Exit interview. Copy of report provided to the Administrator.the state’s words, verbatim · CDSS document, Oct 2, 2024