Canyon View Pacific Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) E. Conchas made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with a care giver Unice and was granted entry to the facility. Danielle arrived at facility shortly after LPA arrival and assisted LPA on the tour. At the time of the initial arrival visit there were was one (1) staff present. The facility is two-story home with eight (8) bedrooms and seven (7) bathrooms. LPA was accompanied by Danielle to conduct a general overall inspection. The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 73 degrees F. LPA inspected resident bedrooms; they are equipped with required furniture, storage space, and sufficient lighting. The 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 restroom to be between 115-127 degrees F. A “Caution Hot” sign was posted on the bathroom mirror. LPA observed multiple Fire extinguishers around the facility to be serviced on June 17, 2026, and August 11, 2026. LPA observed personal rights, the CCLD complaint poster, LTC ombudsman, Liability insurance, Personnel Report LIC 500, Facility Roster LIC 9020, administrator certificate, Facility license, and the Emergency disaster plan were posted in a common area. Continue to LIC809C LPA observed Sharps, and other dangerous items were kept inaccessible to residents in care. Perishable and non-perishable food supply was observed and sufficient for the number of residents in care. LPA observed designated storage space for residents and staff files. There is a Medicine cart with the resident’s medications locked. LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings with Tuberculosis (TB) test result. Medications/Medication Administration Record (MAR) were audited at random. LPA observed the following issues and deficiencies were cited; · An infection control plan was not available for view. · Fire clearance was not completed or available for view · Proof of staff trained on emergency disaster plan missing. · Staff 1, S2 and S3 did not have a TB test result on file. · No current staff schedule · R1 had an incomplete file. Medical assessment missing and admission agreement incomplete. R2 medical assessment incomplete. R3 all file forms were incomplete. · R3 did not have current TB test results. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report and Appeal Rights were discusse to care staff, Danielle Caliliw and provided a copy via email to administrator.the state’s words, verbatim · CDSS document, Sep 22, 2026

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Uncleared staff are working at the facility.

Licensing Program Analyst (LPA) E. Conchas conducted an unannounced visit to the facility to commence a complaint investigation and deliver findings on the allegations stated above. LPA observed the facility, conducted interviews with staff, residents and witnesses. Uncleared staff are working at the facility. LPA interviewed staff and conducted record reviews. Interview with staff reveal S2 has been working at the the facility for over a week. Facility records indicate the earliest S2 signed in in the employee sign-in sheet was May 2nd through May 7th, 2026. Records observation of S2 file did not reveal any clearance record. CCL records indicate staff was not associated until May 12th, 2026. Based on the interviews and observation this allegation is Substantiated Based on interviews, and record review, the allegation is SUBSTANTIATED. The finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where a copy of this report and appeal rights were discussed and provided to Administrator, Iren Crieghton. Substantiated License is not serving a balanced meal. Interviews with staff and residents revealed that staff do provide food for residents during breakfast, lunch and dinner. For breakfast clients were served waffles, eggs, sausage and orange juice. During lunch time, LPA observed a meal provided of fried chicken, Barbecue beans, potato salad and cottage with strawberries and banana for dessert. Based on the interviews this allegation is UNSUBSTANTIATED. Based on the information above, the allegations are unsubstantiated. A finding of UNSUBSTANTIATED means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed, and a copy was provided to administrator Iren Creighton.the state’s words, verbatim · CDSS document, May 27, 2026 · control 56-AS-20260526155400

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: May 28, 2026

87355Criminal Record Clearance(e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17 (2)Obtain a California clearance or a criminal record exemption as required by the Department or. THis requirement is not met as eviddenced by: Based on interview and record review licensee did not comply with the section cited above by allowing staff 2 (S2) to sign in the staff sign in sheet five different days prior to obtaining a California clearance to work at this facility.the state’s words, verbatim · CDSS document, May 27, 2026

Plan of correction: Licensee to obtain a clearance for S2, associate them to the facility and maintain an employee file at the facilty and provide a copy to LPA by POC date.

Type of visit: Case Management - Other

On 4/29/2026, Licensing Program Analyst (LPA) E. Conchas conducted an unannounced case management visit to follow up on complaint 56-AS-20260108125758. LPA was greeted and explained the reason for the visit to caregiver Daniel Caliliw. LPA conducted interviews with residents. During the tour, LPA noticed and observed there was no complaint poster posted anywhere in the facility. A deficiency was cited. LPA observed 2 new staff during the visit. LPA verified their clearance which were both cleared. Iren arrived later around 10:30 am. LPA completed interviews. A deficiencies was cited per California Code of Regulation, Title 22 an exit interview was conducted with Iren, administrator where a copy of this report and the Appeal Rights were provided.the state’s words, verbatim · CDSS document, Apr 29, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468(c)(2)(A) · Plan of correction due date: May 27, 2026

87468 (c) (2) (A) Personal Rights(A)Licensees..The poster that is posted shall be 20" x 26" in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above by not having a complaint poster posted in the main entry which poses a personal rights risk for clients in care.the state’s words, verbatim · CDSS document, Apr 29, 2026

Plan of correction: Licensee shall post the poster measuring 20" x 26" in size and be posted in the main entryway of the facility by POC date and to maintain it posted at all times.

Type of visit: Case Management - Health Checks

During today's visit, LPA conducted a health and safety check, reviewed facility records, and did a walk-through of the facility. LPA found the following issue: Physical plant/ Record Review: LPA reviewed all resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed licensee did not have complete or available personnel records for staff. A Deficiency issued. LPA reviewed nine (9) resident files. three (3) residents had an incomplete admission agreement. Deficiency issued. LPA observed in room eight there were two beds. Resident 3 was observed residing and bed bound. R4 who is bedridden is currently in the hospital. LPA observed No fire clearance for bed ridden resident and to have two residents in room eight. Deficiencies cited with civil penalty. According to physician report records there are five (5) residents who are non ambulatory. One resident did not have an updated report for their medical assessment. Deficiency issued with civil penalty. Medications was not audited due to time management. Deficiencies and civil penalties were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC421IM and appeal rights were discussed and copies were provided to the Administrator for Amanda Santos.the state’s words, verbatim · CDSS document, Nov 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(1) · Plan of correction due date: Nov 7, 2025

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting...This requirement is not met as evidenced by: Based on observation, interview and record review the Licensee has two residents residing in room eight(R3 and R4) and R3 was observed possibly be bedridden without having a fire clearance which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will remove resident to an appropriate room by POC and get an updated phyisican report including the ambulatory status of residents.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87202(a)(2) · Plan of correction due date: Nov 7, 2025

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting:.. (2) Bedridden person.This requirement is not met as evidenced by: Based on observation, interview and record review the LPA observed bed for R2 is in room seven whom is bedridden which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will relocate resident 2 from bedroom seven to bedroom two by POC

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Nov 20, 2025

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Based on observation, interview and record review the licensee did not have personnel records available for review for S1 and no training complete for S2 and S3 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will provide training completed and copies of updated files to LPA by POC.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(b) · Plan of correction due date: Dec 1, 2025

(b) Each resident's record shall contain at least the following information: This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above by not having complete resident records: no or incomplete admission agreements, preappraisals, revised appraisals, updated medical assessments which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee will will update resident files and have complete phyisican report, prepappraisals or anyother medical assements required for ambulatory status.

Type of visit: Prelicensing

Licensing Program Analyst (LPA's) Edith Conchas and Sarina Ramirez conducted an announced visit to the facility for the purpose of a Change of Ownership evaluation. LPA met with the licensee Nitin Vermani (Nick) and Administrator Amanda Santos. An initial application for change of ownership to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Centralized Applications Bureau (CAB) on 3/22/2024 for a total capacity of 14 residents. Fire clearance was granted on 7/22/2025. LPA observed the following: The facility is two-story home with eight (8) bedrooms and seven (7) bathrooms. RSD alarms completed a fire alarm inspection on April 9th, 2025.The physical plant, in general, was in good repair. Buildings and grounds are free from hazards. Indoor and outdoor passageways were free of obstruction. There is a locked area for medications, cleaning supplies, and sharps. LPA observed a working telephone and basic laundry equipment. Resident bedrooms had the required bedding and furniture. Bedrooms had sufficient lighting. LPA measured the hot water temperature in one (1) resident bathroom measuring at 122.4 degrees F. sign has been posted until water temperature adjusts per regulation. The facility had a sufficient amount of linen and hygiene items for the residents. The facility had a sufficient amount of nonperishable and perishable food items. The food was kept in a safe and healthful manner. The facility menu was available for review. Dishes, glasses, and utensils were in good condition. The facility had a designated area for staff and resident records. Facility sketch, personal rights, CCLD complaint poster, Ombudsman poster, and schedule of activities were posted in a common area. The facility was equipped with a complete first aid kit and manual. There is adequate seating in the common areas. Facility had a supply of activities for the residents. Pre-licensing inspection is complete, and no corrections are needed to be made. Facility appears to be ready for licensure. An exit interview was conducted where this report was discussed and provided to the licensee Nitin Vermeni (Nick) and Administrator Amanda Santos. Composition III was completedthe state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Prelicensing

Licensing Program Analyat (LPA) Edith Conchas conducted an announced visit to the facility to conduct a pre-licensing inspection. LPA met with licensee Nick Vermani and adminsitrator Amanda Santos . Based on initial observations made by the LPA, the pre-licensing inspection is not able to be completed at this time due to LPA's observation of back yard conditions. LPA and licensee will reschedule a pre licensing inspection once corrections have been completed and all other elements of the pre-licensing checklist are complete. Cleaning/ laundry supplies need to be locked up. Medication should be in a designated locked area. Backyard should be free of debris, have clear pathways. Any gardening tools, chemicals or broken furniture extra equipment should be stored removed. Gazebo steps should be repaired due to accessible to residents. Freezer needs to be in working condition. Pre-Licensing is incomplete. A follow up Pre-Licensure LIC 809 will be generated upon completion. An exit interview was conducted where is report was discussed and provided tothe state’s words, verbatim · CDSS document, Aug 13, 2025