Madera Villa Residential Care

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this one level RCFE. There are 15 private client bedrooms--12 of which have half bathrooms--dining, reading and living rooms, office, staff room, kitchen and 2 shower/bathrooms. A driveway and parking lot partially surround facility grounds; there is a patio with seating, and a detached storage unit in the rear. No accessible bodies of water or fire safety hazards are observed. Carbon monoxide detector is tested as operational. Washer and dryer are located on site. Each resident is issued a pendant alarm, which transmits an audible alert to staff in main hallway and staff room, that identifies the resident. Food supplies are adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Hot water temperature tested at 111 degrees F in shower/bathroom. Soap and paper towels are present in bathrooms and kitchen sink. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is accessible. There is one resident receiving hospice services. Criminal record clearances or exemptions for facility staff or other individuals who have client contact are reviewed, as well as other staff and training records. Client records, including Centrally Stored Medications Records, are reviewed. Georgina Chavez is a certified RCFE administrator (x 10//27) that oversees facility operations with licensee Alan Tuan. The following information/forms are requested to be updated and submitted to CCLD BY 8/12/26: - Proof of current liability insurance - Emergency Disaster Plan (LIC610E, including signature on 9th page) Updated Personnel Report (LIC500) is provided to LPA today. Deficiencies of the California Code of Regulations, Title 22, Division 6, are cited on following pages. Also see Technical Advisory Notes--2 pages--for additional information.the state’s words, verbatim · CDSS document, Jul 29, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(3) · Plan of correction due date: Aug 12, 2026

POSTURAL SUPPORTS A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record... This requirement is not met, as there are half bed rails on all but one bed, but there are no MD orders maintained. Licensee failed to ensure that MD orders are maintained for those who use half bed rails. This poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: MD orders shall be obtained and copies of MD orders to be sent to CCLD BY DUE DATE for clients #1 - #5, referenced on LIC858. MD orders to be maintained and available for review for all other residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(e) · Plan of correction due date: Aug 12, 2026

INCIDENTAL MEDICAL CARE For every RX and non RX medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. This requirement is not met, as there is no MD order maintained for OTC tumeric/curcumin 1950 mg & Vit K2/D3 125 mcg/90 mcg for client #1. Licensee failed to ensure that MD orders are maintained for OTC meds, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: Written MD orders for OTC supplements for client #1 will be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Aug 12, 2026

FOOD SUPPLY Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met, as there is an insufficient 7-day supply of canned fruits and vegetables maintained. Licensee failed to ensure that there is a 7 day nonperishable supply of fruits and vegetables maintained, which poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: Receipt for purchase of at least 7-day supploy of canned fruits and vegetables will be sent to CCLD BY DUE DATE

Allegation investigated: Staff are not ensuring a resident is compliant with their medications Staff hit a resident Resident sustained multiple bruises due to staff neglect or physical abuse Staff is retaliating against a resident

On March 30, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Administrator, Alan Tuan and explained the purpose of the visit. Regarding the allegation, staff are not ensuring a resident is compliant with their medications, according to the reporting party, Resident 1 (R1) is self-neglecting by not taking his/her currently prescribed Seroquel and Zoloft due to R1's paranoia. According to the reporting party, R1 does not want to be controlled by the medications and believes the medications are poising him/her. In addition, reporting party indicated that the facility is not doing anything wrong and is reporting the medication refusals to required parties. During the investigation, LPA reviewed R1's file, interviewed the administrator and R1's care manager. Based on R1's file reviewed, R1 has a diagnosis of dementia and anxiety disorder associated with paranoia, depressions and experiences hallucinations. According to the administrator, R1 frequently refuses prescribed medications and has been observed hiding medications in various locations, including near his/her bed and in gaps between furniture. Administrator indicated when R1 refuses medications, the private caregiver, hired by family through Sage Elder Care Solution documents the refusal and communicates with the physician, however, the facility does not have documentation of these communications, as they occur between Sage Elder Care Solutions and the POA. (continue to 9099C) Unfounded According to the Care Manager interviewed, the facility is not doing anything wrong. All medications are given as prescribed, however R1 refuses to take them. Care manager indicated that they are notified everytime R1 refuses his/her medications. Regarding the allegation staff hit a resident and resident sustained multiple bruises due to staff neglect or physical abuse, according to the reporting party, during a video visit with R1's psychiatrist, R1 indicated he/she was assaulted and was punched by the administrator causing bruises on R1's palms and all over his/her body. No date or time was provided. Reporting party indicated that this complaint was only filed because he/she is a mandated reporter, however this allegation is unfounded because R1 has a history of making up stories. During the investigation, LPA reviewed R1's file, interviewed the administrator and R1's care manager. Based on R1's file reviewed, R1 has a diagnosis of dementia and anxiety disorder associated with paranoia. According to the administrator, he denied this allegation and indicated he has not had physical contact with R1 nor has he observed any visible bruises on R1. In addition, the Care Manager and private caregiver from Sage Elder Care Solutions did not observe any bruises or injuries and no staff, caregivers, or other parties independently reported concerns of abuse to either of them. Regarding the allegation, staff is retaliating against a resident, according to the reporting party, the administrator is retaliating against R1 and victimizing R1 because of the complaints previously made. No further information is forthcoming. Reporting party indicated that this complaint was only filed because he/she is a mandated reporter, however this allegation is unfounded because R1 has a history of making up stories. During the investigation, LPA interviewed the administrator and care manager. According to the administrator, he denied this allegation and indicated that R1 makes accusations against him and the staff, however for most of the day, R1 has a private caregiver that provides care to R1 and for hours that there is no private caregiver, R1 remains in his/her room and two facility staff attend to her when required. According to the Care Manager, R1 has not provided them with specific retaliatory action by facility staff. Care Manager indicated that he/she has not personally witnessed any retaliation and indicated that the facility is not doing anything wrong. Due to R1's behaviors, R1 has a history of making up stories. Based on the above information, the Department has found that the above allegations are to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. Report is reviewed with administrator and a copy is provided.the state’s words, verbatim · CDSS document, Mar 30, 2026 · control 26-AS-20260115112354

Type of visit: Required - 1 Year

On July 07, 2025, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrator, Alan Tuan, and disclosed the purpose of the inspection. The Administrator informed the LPA that the facility had (12) residents in care and (3) staff members present at the time. At 8:55 AM, the LPA initiated a walk-through of the facility, accompanied by the Administrator. The indoor temperature reading of 75°F on a thermostat was observed in the hallway at the time of the visit. LPA inspected the kitchen and observed breakfast service was in progress at the time. The appliances were checked and observed to be in working order. The LPA observed a locked lock box on the kitchen countertop containing knives and sharp objects. LPA inspected a locked cabinet under the sink containing detergents, disinfectants, and cleaning supplies. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for two (2) days and nonperishable staples for seven (7) days were observed. No expired food or stored medications were noted. LPA inspected the dining area adjacent to the kitchen. One (1) resident was observed to be sitting in the dining area eating breakfast. LPA inspected the living room and observed a sofa, chairs, tables, a piano, and a television in the living room. Two (2) residents were observed sitting in the living room watching TV. Board games, puzzles, arts, coloring, bingo, and other recreational activity items for residents’ activities were also observed in the living room. LPA inspected the fire extinguisher mounted on the wall in the hallway and found it fully charged, with the last service tag dated 07/10/2024. The Administrator tested the smoke and carbon monoxide detector located in the office room in the LPA's presence, and it was found to be functional. Continued on LIC809-C There were fifteen (15) bedrooms designated for residents' use. All (15) resident rooms were single occupancy. LPA inspected random six (6) resident rooms and found them clean, well-lit, and equipped with the required furniture. LPA inspected half bathrooms in these random rooms and found them in working condition. The bathrooms contained soap, grab bars, towels, and a trash can. The hot water temperature at the sink faucet measured between 118.2°F to 119.5°F in these bathrooms. LPA observed men and women bathrooms in the hallway for shower with a shower chair, non-slip mats, and grab bars. LPA observed a laundry area in the hallway with a washer and a dryer. The laundry detergents, cleaning solutions, and disinfectants, were observed locked in a closet next to the backside door. LPA inspected a dresser in the hallway and observed it containing clean linen supplies. LPA toured the backyard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. The backyard had a set of a patio table, chairs, and a gazebo for resident use. No accessible bodies of water were found. LPA inspected one (1) storage shed and observed refrigerators, freezers, and pantry food items stored in the shed. At 10:25 AM, LPA reviewed five (5) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had an Admission Agreement and current Physician's Report. LPA observed that 3 of 5 residents did not have Pre-Admission Appraisal, 5 of 5 residents didn’t have Functional Capabilities Assessment, and 4 of 5 residents didn’t have current Appraisal Needs and Services Plan. LPA observed that 5 of 5 staff members had LIC 508 Criminal Record Statements, LIC 503 Health Screening, current first aid certificates, and confirmed that 5 of 5 staff members were associated with the facility. LPA observed a locked centrally stored medication cabinet located inside in the hallway near the backside door. Medications were organized separately for each resident. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. At 11:35 AM, LPA asked the Administrator for an Emergency Disaster Drill log. The Administrator didn’t have Emergency Disaster Drills logs for LPA to review, and LPA was not able to verify if the drills are conducted quarterly at the facility. Continued on LIC809-C LPA inspected the first aid kit and found it fully stocked. The following updated forms are requested to be submitted to CCLD by 07/14/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and provided to the Administrator, Alan Tuan, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 7, 2025

Allegation investigated: Uncleared staff are providing care to residents. Facility does not have enough staff to adequately care for residents.

On April 10, 2025, at 12:20 PM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to deliver the findings of a Complaint Investigation. Upon arrival, the LPA was greeted by the Administrator (ADM), Alan Tuan. The LPA disclosed the purpose of the inspection. Regarding the allegation that “Uncleared staff are providing care to residents”, the Reporting Party (RP) stated “It has come to my attention that the facility's boss has been employing illegal workers for many years, paying them in cash to evade taxes. These workers live in the nursing home and are expected to work every day, without any days off, to care for the elderly residents. Regarding the allegation that “Facility does not have enough staff to adequately care for residents”, the Reporting Party (RP) stated “Despite the nursing home's official registered staff count being five, there are actually only two, some time three legitimate staff members working on site. Continued on LIC9099-C Unsubstantiated This significant shortage of nursing staff means that each worker must care for four or five elderly people on their own, which is unacceptable and unsafe”. On April 3, 2025, LPA toured the facility. LPA observed a total of four (4) staff members on-site: one (1) Administrator and three (3) caregivers. Two (2) caregivers were assisting residents with lunch in the dining room. One (1) caregiver was observed standing in the main hallway, while the Administrator was seen conversing with a resident and their visiting family. No additional staff members were observed at the facility aside from the three caregivers and the Administrator. All four (4) staff present at the time were associated with the facility. LPA visited six resident rooms, the dining room, the Administrator’s office, and an employee-only staff room. On April 3, 2025, LPA reviewed six (6) staff records and confirmed that all six staff members were associated with the facility. The Administrator and Staff Member 5 (S5) had been employed at the facility since 1988. Staff Member 4 (S4) had been working there since 1998, and Staff Member 3 (S3) since 2006. Staff Members 1 (S1) and 2 (S2) had both been employed since 2023. LPA conducted interviews with four (4) staff members: the Administrator (ADM), S1, S2, and S3. The Administrator reported having five (5) full-time and two (2) part-time staff. ADM stated that during the day shift, three to four staff members were typically present, while two staff members were always scheduled for the night shift. On Tuesdays and Wednesdays, five staff members were scheduled to work. Only S2 stayed at the facility. S1, S2, and S3 stated that they were paid by check twice a month, on the 15th and 30th, and that they always received their pay on time, including any overtime compensation. They further stated that they enjoyed working at the facility and described the Administrator as very nice. LPA interviewed four (4) residents: R1, R2, R3, and R4. R1 stated they liked living at the facility and that care staff always responded promptly to call button requests. R2 shared that the care staff made genuine efforts and provided good care. R3 expressed satisfaction with the quality of care received. R4 mentioned that the staff had remained mostly the same over the past two years, describing them as good people with whom they had no issues. R4 did note occasional language barriers with staff but said it was not a frequent issue and overall, the staff did a very good job. Continued on LIC9099-C Additionally, LPA interviewed one (1) family member (FM1) of a resident. FM1 expressed peace of mind knowing their loved one was receiving good care and stated that the Administrator was very caring, often checking on residents seven to eight times a day. Based on observations, interviews conducted, and records reviewed, the department has determined that the allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies were cited under the California Code of Regulations, Title 22. An exit interview was conducted with the Administrator. A copy of this report was discussed and provided to the Administrator, Alan Tuan, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Apr 10, 2025 · control 26-AS-20240425165038

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Alan Tuan. 12 residents and 4 staff were observed in the facility. License, an expired Administrator Certificate, and personal rights posters were observed in the facility. ADM provided the documents that he/she renewed the Administrator Certificate already. LPA reviewed 6 resident files and 4 staff files. One resident file was observed without Appraisal/Needs and Service form. 2 resident files were observed the centrally stored medication forms were not updated and not matching with the medications. LPA toured the facility inside out with ADM. 15 resident single rooms, 1 staff live-in room, 1 office, 1 storage room, living room, dining room, two common restrooms and kitchen were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication room was observed locked. Knives closet was observed unlocked, ADM locked the knives closet immediately. Cleaning product closet were observed unlocked. ADM put an lock and locked the cleaning product closet before LPA finished the inspection. Room temperature was at 76 degree F, and hot water temperature was at 118 degree F in facility. Emergency light system, first aid box, night lights, and flash lights were observed at the facility. ADM and LPA tested the signal system, and it works fine. The last time the facility conducted the emergency drill is 7/10/2024. Continue on LIC809-C. Page 1 of 2. Fire extinguisher was serviced on 7/10/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and it was working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. One storage room was observed at the backyard. Deficiency was noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM. Page 2 of 2.the state’s words, verbatim · CDSS document, Jul 18, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.