Villa Teresa 1 Care Home

Type of visit: Required - 1 Year

On 03/07/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua was greeted by Facility Designated Representative (FDR), Allan Jose and JJ Jose and explained the purpose of the visit. Current census was 5. Upon arrival LPA Pascua observed 2 residents leaving the facility for a weekend outing. This facility is licensed to serve residents who at 60 and older, 4 out 6 residents may be non-ambulatory but cannot reside in the middle bedroom. This facility also has a dementia plan on file and has a hospice waiver for 2 residents. This facility is also vendorized by Valley Mountain Regional Center to accept and retain Level 7 residents. There is current 1 resident on hospice, 1 resident obtaining home health services. LPA Pascua reviewed 5 resident files and 5 staff files. LPA Pascua provided technical assistance to FDR Jose regarding dementia regulations, physicians reports, needs and services plans, and administrator certification. A tour of the facility was conducted. Fire extinguisher located by the back door appeared to have been serviced 07/29/2025 by Jorgenson Co and is in compliance. The kitchen area was toured. LPA Pascua observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional refrigerator located in the garage. Knives and additional cleaning supplies were locked and made inaccessible to the residents at this time. LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with facility staff, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components. Common areas were toured. Living room, dining area and all other areas intended for resident use were in compliance and good repair. A washer and dryer were also identified. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of the garage was conducted. Additional storage for supplies were stored in cabinets. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. Grab bars were present and in good repair. A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. The exterior of the physical plant was toured. LPA Pascua observed several wood planks hanging from the fence and a large concrete block that has been broken due to the surrounding tree. LPA Pascua also observed several broken window screens. The following forms and documents were requested to be updated and submitted into CCL. -LIC 308 -LIC 400 -LIC 500 -LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were reviewed and a copy was printed and given to the facility designated Administrator at this time.the state’s words, verbatim · CDSS document, Mar 7, 2026

Allegation investigated: Resident sustained injury while in care due to lack of supervision

On 2/20/2025 at 3:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with Administrator Justin Jose and explained the purpose of the visit. During this investigation, LPA conducted interviews with three staff members and resident1 (R1). LPA also reviewed facility file documentation including individual program plan (IPP), behavior support plan, and physician’s report, and care notes all pertaining to R1. Additionally, LPA reviewed facility’s staffing schedule and conducted facility observations on 12/30/24 and 2/20/2025. Allegation: Resident sustained injury while in care due to lack of supervision. Based on interviews and record reviews conducted, it was revealed that on 12/22/24 R1 experience a fall and sustained a bruise on right eye. Staffing schedule reviewed for this date and other dates in December 2024 revealed two staff on duty consistently for 6 residents in care. Additionally, it was determined through interviews that resident fell as a result of tripping over clothing items in her room and making contact with bedroom furniture. {Cont. on 9099C} Unsubstantiated Care notes reviewed indicate fall was noted and addressed on 12/22/24 by staff. Record reviews and interviews further revealed that R1 has a history of resisting staff assistance with cleaning room and lacks safety awareness. Behavior support plan for R1 indicates interventions are in place to address this behavior. Observations conducted revealed facility staff attending to residents needs adequately. As a result, although R1 sustained a fall and minor injury while in care, there is not a preponderance of evidence to conclude this was due to a lack of appropriate supervision. Therefore, the above allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator and a copy of this report was provided. Appeal rights provided.the state’s words, verbatim · CDSS document, Feb 20, 2025 · control 27-AS-20241223172423

Type of visit: Required - 1 Year

On 2-20-2025 at 11:00am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Justin Jose and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a Residential Care Facility for the Elderly (RCFE) with a current census of 4. Facility has 4 bedrooms and 2 bathrooms for resident use. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 2 ambulatory residents, 2 non ambulatory residents, 0 hospice, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 71*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked and is fully charged. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed and contained accompanying regulatory required Physician’s orders. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 4 resident files and 5 staffing files were reviewed for regulatory compliance. Five of five files reviewed did not contain all regulatory required staff training. All staff noted on LIC 500 contained criminal background clearances. {Cont. on 809C} LPA completed 1 resident interviews and 2 staff interviews. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s surety bond and liability insurance is current and up to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts monthly fire drills. LPA requested an updated copy of LIC 308, LIC 500, updated surety bond, and updated liability insurance to be sent by 2-27-2025 Per California Code of Regulations, Title 22, deficiencies were observed during this visit and noted on LIC 809D. Exit interview was held and a report was given to Administrator. Appeal rights provided.the state’s words, verbatim · CDSS document, Feb 20, 2025

Type of visit: Annual/Random

On 3-13-2024 at 12:58pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Justin Jose and explained the purpose of the visit. This visit is the result of a previously attempted annual visit conducted on 2-16-24. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a residential care facility for the elderly with a current census of 6. Facility has 4 bedrooms and 2 bathrooms for resident use Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 0 ambulatory residents, 6 non ambulatory residents, 0 hospice, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 73*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 7-28-23. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed and contained accompanying regulatory required Physician’s orders. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 5 resident files and 5 staffing files were reviewed for regulatory compliance. All files contained required contents including staff training. {Cont on 809C} All staff noted on LIC 500 contained criminal background clearances. LPA completed 2 resident interviews and 2 staff interviews. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s surety bond and liability insurance is current and update to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts monthly fire drills. LPA requested an updated copy of LIC 308 and LIC 500. LPA observed facility to have a designated ambulatory room occupied by non-ambulatory residents per regulatory definition. Per California Code of Regulations, Title 22, deficiencies were observed during this visit and noted on LIC 809D. In addition, an immediate civil penalty in the amount of $500 is issued due to fire clearance violation. Exit interview was held and a report was given to Administrator Justin Jose. Appeal rights provided.the state’s words, verbatim · CDSS document, Mar 13, 2024

The state marks this report as 9 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 2-16-24 at 10:22am, Licensing Program Analyst (LPA) Michael Bilger arrived at facility unannounced to conduct an annual inspection. LPA knocked on the door and rang bell; waiting for 15 minutes. LPA called facility and spoke with facility staff who was at another location and informed LPA all clients were in day program. LPA called and spoke with Administrator Justin Jose, who confirmed all resident were in day program and was away from facility for extended time due to a previously scheduled appointment. LPA was unable to complete this annual inspection as a result. LPA will re-attempt visit at a later date. No citation issued today. An exit interview was conducted with Justin Jose via phone and a copy of this report was mailed to Justin with a request for return with signature.the state’s words, verbatim · CDSS document, Feb 16, 2024