Villa Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Douglas Baker and was granted entry to the facility. At the time of the visit there was three (3) staff present, and five (5) residents present. The facility is a six (6) bedroom, four (4), bathroom home, with a kitchen/dining area, living room, with an attached garage. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (6) current census (5). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside kitchen cabinet inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed four (4) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Douglas Baker.the state’s words, verbatim · CDSS document, Jul 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Douglas Baker and was granted entry to the facility. At the time of the visit there was three (3) staff present, and six (6) residents present. The facility is a six (6) bedroom, four (4), bathroom home, with a kitchen/dining area, living room, with an attached garage. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (6) current census (6). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside kitchen cabinet inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed four (4) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Douglas Baker.the state’s words, verbatim · CDSS document, Oct 8, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Douglas Baker and was granted entry to the facility. At the time of the visit there was two (2) staff present, and five (5) residents present. The facility is a six (6) bedroom, four (4), bathroom home, with a kitchen/dining area, living room, with open driveway. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (6) current census (5). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms to be 112 degrees F The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside kitchen cabinet inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed five (5) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Douglas Baker.the state’s words, verbatim · CDSS document, Oct 2, 2024

Allegation investigated: Staff are not trained sufficiently. Facility failed to report incidents.

Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation(s) noted above. LPA met with Douglas Baker, Administrator and explained the purpose of the visit and elements of the allegation(s). The allegations were investigated, the investigation consisted of observations, interviews and records review. On 06/26/20, Community Care Licensing received a complaint alleging that staff are not trained sufficiently. It was reported that staff did not know how to lift a bedridden resident. In regards to the allegation, the information reported could not be corroborated. Per interviews conducted with facility staff they received training and that Resident #1(R1) would become aggressive and not want care to continue. Staff could not recall if R1 was a two person assist. Additionally, staff reported the training received consists of online, reading materials/booklets and then tests. In addition, LPA reviewed 5 facility files and observed for there to be training checklist, showing proof of ongoing 20 hours of training received Substantiated annually. However, LPA observed that no staff files had a current CPR/First aid training certification. Based on records review the allegation of staff are not trained sufficiently is SUBSTANTIATED. Facility failed to report incidents. It was alleged that Resident #1 (R1) had their ring and watch stolen from Staff # 1 (S1). In addition, some facility camera equipment was also observed to have been stolen. Per interviews conducted with the Licensee, Roger Baker and Administrator, Douglas Baker, R1s responsible party reported that their ring and watch was stolen. However, the items were not locked up for safe keeping by staff. Licensee and Administrator stated that a police report was filed with Rancho Cucamonga Sheriff’s department. Per Licensee and Administrator, the items were unable to be retrieved, but the camera equipment was located at in different county. LPA conducted a review of the facility files and the incident was not reported to the department. Based on interviews and facility file reviews, the allegations are SUBSTANTIATED. A finding that the complaint allegations are substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Facility is cited in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8), which poses a potential health, safety and/or personal rights risk to persons in care. An exit interview was conducted and a copy of this report, LIC 9099-D, and appeal rights were provided to Administrator Douglas Baker. Therefore the allegation of staff did not seek emergency medical care in a time manner is UNSUBSTANTIATED. There are not enough competent staff on duty to care for residents' needs. It was reported that there are not enough competent staff on duty to care for residents’ needs. Per interviews conducted with the Administrator Douglas there was a brief time for the month in September 2020, where the facility was having a challenging time with facility staff not getting along. There were some staff that expressed that they no longer wanted to work at the facility if there were certain staff still there. Due to the issues with staff, certain staff received additional hours to ensure residents were properly cared for and supervised. Further information from staff interviews, Resident #1 (R1) was described as being aggressive at times and would refuse care. R1 is unable to be interviewed as they are deceased. The facility is licensed for six (6) residents and currently has a census of six (6) residents. The facility currently has a total of 14 staff on the roster. During the AM and PM shift there are 2 caregivers on in addition to the Administrator being present on grounds. During the Noc shift there is a wake caregiver as well as the administrator that lives on the premises. Due to insufficient evidence to corroborate the allegation of there are not enough competent staff on duty to care for residents’ needs is UNSUBSTANTIATED. Facility is not screening staff prior to hiring. It was reported that the facility is not screening staff prior to hiring. LPA conducted a review of six (6) staff files and observed for the staff files to have a Caregiver employee verification checklist completed. All staff currently working at the facility have obtained criminal record clearance and are associated to the facility. Per an interview with Administrator Douglas, posting the job using an online hiring search engine, the screening process includes reviewing the applicants background, an interview which includes asking what their desires are, referral review, and if the applicant has reliable transportation. Administrator Douglas stated that he is the one that is responsible for hiring staff and that all staff are screened in person. Based on a records review and interviews the allegation is UNSUBSTANTIATED. Staff stole items from resident. It was alleged that Resident #1 (R1) had their ring and watch stolen from Staff # 1 (S1). In addition, some facility camera equipment was also observed to have been stolen. Per interviews conducted with the Licensee Roger Baker and Administrator Douglas Baker, R1 did in fact have their ring and watch stolen. However, the items were not locked up for safe keeping by staff but was on R1s person. The licensee and Administrator stated that a police report was filed with Rancho Cucamonga Sheriff’s department. Per licensee and Administrator Baker, the watch and ring were unable to be retrieved, but the camera equipment was located at a pawn shop in a different county, as there were serial numbers on the equipment. Additional feedback from interview with Administrator S1 was “arrested and put back into prison”. Based on interviews, record review, and observation, the allegations listed above are UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. Based on interviews the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided to Douglas Baker, Administrator. prison”. Further, per Administrator, residents and their responsible parties are encouraged to not to bring anything that they define as valuable. The following statements are documented or verbally expressed ”Per the facility’s theft and loss program the facility does not accept residents cash or belongings that are valuable”. “Personal property inventory shall be completed by the responsible party of the resident”. LPA attempted to conduct resident interviews and LPA was unable to successfully obtain information. Based on interviews and records review the allegation of facility failed to safeguard resident’s property is UNFOUNDED. An exit interview was conducted and a copy of this report was provided to Douglas Baker, Administrator.the state’s words, verbatim · CDSS document, Jan 16, 2024 · control 18-AS-20200626143915

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.618(c)(3) · Plan of correction due date: Jan 17, 2024

1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling (c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidence by 6the state’s words, verbatim · CDSS document, Jan 16, 2024

Plan of correction: staff not having CPR certification. The Licensee agrees to enroll all staff to . Proof of plan of correction is to be submitted to the department by 5pm on the due date indicated. The Licensee agrees to enroll staff in CPR/First Aid, training. Proof is to be submitted to the department by 5pm on the due date indicated.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Jan 31, 2024

Reporting requirements87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including...the following: (1) A written report shall be submitted to the licensing agency...within 7 days of the occurrence of any of the events...the state’s words, verbatim · CDSS document, Jan 16, 2024

Plan of correction: Licensee agreed to conduct staff training on reporting requirements. The training material and sign-in sheet will be provided to the Department as proof of POC by the due date.

From the deficiency page — Deficiency type: Type B

This requirement was not met, as evidenced by: Based on interviews and record review, the Licensee did not ensure the theft was reported to the Department within 7 days of the occurrence.This poses a potential risk to the health, safety or personal rights of the residents in care.the state’s words, verbatim · CDSS document, Jan 16, 2024