Verna's Care Home

Type of visit: Post Licensing

At 9:50 A.M. Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced Post-Licensing Inspection of the above-listed facility. Upon arrival LPA met with Licensee, Evelyn Stevens. Entrance interview conducted. An updated Fire Clearance was approved on 03/10/2026, for a total of five (5) non-ambulatory residents and one (1) bedridden resident. Furthermore, the licensee was granted a hospice waiver for six (6) residents. LPA Conway provided an updated license. Licensee replaced facility license and surrendered their original license. At 10:15 A.M. a tour of the physical plant was conducted. This facility doesn’t have a staff room; facility will provide 24/7 care. Fire extinguisher was observed to be fully charged and last purchased on 02/04/2026. Between 11:01 A.M. 11:06 A.M., hardwired smoke detectors and a separate carbon monoxide detector were tested and were functional at the time of the visit. Facility is equipped with a fire door to enhance safety and prevent the spread of fire, and it was operable during today’s visit. Bedrooms: The facility has two (2) single bedrooms and two (2) shared bedrooms designated for residents use only. All bedrooms were furnished appropriately with clean linen, appropriate furnishings and sufficient lighting. No resident bedroom will be used as a public or general passageway to another room, bath, or toilet. There were no visible hazards or discrepancies observed. Continued on LIC 809-C Continued from LIC 809 Bathrooms: There are five (5) bathrooms. Each bedroom has its own bathroom and there is one (1) shared bathroom for visitors and staff. LPA observed grab bars for each toilet, and shower used by residents. All bathrooms were supplied with appropriate paper and hygiene products. The water temperature was measured in residents’ bathrooms and initially measured outside the required range; water heater temperature was adjusted during the visit. Technical Violation (TV) issued. Common Areas: These include the Family Room and Dining Room. The common areas were furnished to accommodate a maximum capacity of six (6) residents. Floor surfaces were clean and in good repair. The facility does not have a fireplace. Cameras are installed in common areas; according to the licensee, the cameras do not record audio. The LPA observed nightlights installed in all hallways and passageways. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The facility maintained a temperature of 74 degrees. LPA observed all required posters. Office Room: LPA observed a desk and file cabinets. Staff and resident files will be stored in this room and maintained in a locked manner to ensure confidentiality. Kitchen: The kitchen appeared clean. There was a sufficient supply of perishable and non-perishable food. LPA conducted a review of expiration dates on product labels. Appliances appear to function properly. Knives are stored locked in a kitchen drawer. At 11:10 A.M. hot water measured 121.6 degrees Fahrenheit; water heater temperature was adjusted during the visit. Technical Violation (TV) issued. Garage/Laundry Area: Inside the garage, the LPA observed a washer and a dryer machine. Staff will assist residents with all laundry needs. Additionally, LPA observed an ample supply of emergency water and dried emergency food at the time of the visit. Surrounding Grounds: Garden and front yard are easily accessible to residents, and they are sufficient in size, comfortable and appropriately equipped for outdoor use. Backyard: There was a shaded area with proper furniture for outdoor use. LPA observed one (1) self-closing and latching side gate. There is a locked shed in the backyard that holds gardening tools and extra supplies. LPA observed several gardening beds located in the backyard. LPA advised the licensee that if the gardening beds are used to grow vegetables, the produce shall not be served or provided to residents in care. No bodies of water observed. Continued on LIC 809-C Continued from LIC 809-C RECORD REVIEW: Between 2:00 P.M. and 3:30 P.M., staff and resident records were reviewed. Facility staff and residents’ files are stored in a locked file cabinet in the office room close to the facility’s entrance. Three (3) resident and three (3) personnel records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. LPA advised licensee to use the Resident Property and Valuables (LIC 621) form to keep inventory of resident’s belongings. LPA emailed licensee a list of all required consent forms to be kept inside residents’ files. Technical Assistance (TA) issued. A written hospice care plan was missing for Resident #1 (R1). Technical Violation (TV) issued. Staff records reviewed were all completed. MEDICATION REVIEW: Medications are stored in a locked kitchen pantry. There is a complete first aid kit inside a kitchen cabinet. Between 3:10 P.M. and 4:15 P.M., medications for three (3) residents were audited. During the medication review, the LPA observed that the licensee was not utilizing the Centrally Stored Medication and Destruction Record (LIC622). The licensee provided copies of each resident’s Medication Administrator Record (MAR) and explained that the facility was using the MARs in place of the LIC 622. The MARs reviewed contained the required medication information; however, they did not include medication start dates. The LPA explained the purpose of maintaining a completed LIC 622 for centrally stored medications. The licensee acknowledged the requirement and stated that the facility will begin utilizing the LIC 622 effective immediately. Technical Violation (TV) issued. Each resident's medication was observed stored in its originally received container. Infection Control/Emergency Disaster Planning: The LPA reviewed the facility's infection control plan and the emergency disaster plan. The facility’s policies and procedures as they pertain to infection control and emergency disaster plan are adequate. Continued on LIC 809-C Continued from LIC 809-C During today’s visit, LPA requested the Personnel Report (LIC500), the resident’s rooster (LIC9020), liability insurance and last emergency drill conducted. During today’s visit, the LPA requested documentation of the facility’s most recent emergency drill. The licensee stated that an evacuation drill had been conducted recently; however, no documentation was available to verify the drill. The LPA informed the Licensee that emergency drills should be conducted quarterly, documented and maintained on file. Documentation should include the date of the drill, the names of all staff who participated, and a summary of the training topic or drill conducted. Technical Violation (TV) issued. The LPA provided the licensee with the Technical Support Program’s (TSP) information. This is a non-enforcement program offered by the Community Care Licensing Division (CCLD) that provides services and resources to assist providers in meeting licensing requirements. The TSP is designed to help facilities achieve and sustain compliance through training, support, and access to relevant tools. LPA provided the ED with the following contact information for TSP services. TSP email address TechnicalSupportProgram@dss.ca.gov and their phone number (916) 654-1549. Additionally, LPA advised the ED to review the Provider Information Notices (PINs) on CCLD's website (www.ccld.ca.gov) for further guidance and updates. Exit interview conducted. A copy of the Licensing Report was issued. No citations issued.the state’s words, verbatim · CDSS document, Jun 1, 2026

Type of visit: Prelicensing

At 9:45 A.M. Licensing Program Analyst (LPA) Valeria Conway conducted an announced Pre-Licensing Inspection to the above listed facility. Upon arrival LPA met with Licensee, Evelyn Stevens. Entrance interview conducted. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 09/26/2025. A Fire Clearance was approved on 12/17/2025, for a total of six (6) non-ambulatory residents only. The proposed physical plant is a one (1) story single family dwelling located in a residential neighborhood of Camarillo, CA. This facility will be housing residents with dementia. This pending facility has a dementia care program and a hospice care waiver for two (2) residents. There are currently no residents being served at the facility. This facility doesn’t have a staff room; facility will provide 24/7 care. At 10:05 A.M. tour of the physical plant was conducted. LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. The following observed: Bedrooms: The facility has two (2) single bedrooms and two (2) shared bedrooms designated for residents use only. There was a model furnished bedroom equipped and supplied with appropriate furniture including but not limited to a bed, a chair, a nightstand, a lamp and a chest of drawers, bedding, and linens. No client bedroom will be used as a public or general passageway to another room, bath, or toilet. There were no visible hazards or discrepancies observed. Continued on LIC 809-C Continued from 809-C Bathrooms: There are five (5) bathrooms. Each bedroom has its own bathroom and there is one (1) shared bathroom for visitors and staff. LPA observed grab bars for each toilet, and shower used by residents. All bathrooms were supplied with appropriate paper and hygiene products. Water temperatures were measured in all residents’ bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit. Common Areas: These include the Family Room and Dining Room. The common areas were furnished to accommodate a maximum capacity of six (6) residents. Floor surfaces were clean and in good repair. There were no immediate hazards observed. Fire extinguisher was observed fully charged and last purchased on 02/04/2026. Between 10:21 A.M. and 10:24 A.M., hardwired smoke detectors and a separate carbon monoxide detector were tested and were functional at the time of the visit. The facility does not have a fireplace. Cameras are installed in common areas; according to the licensee, the cameras do not record audio. The LPA observed nightlights installed in all hallways and passageways. The facility has an operational auditory alarm system and is equipped with a fire door to enhance safety and prevent the spread of fire. LPA did not observe the required Personal Rights poster, Ombudsman poster, and the Community Care Licensing (CCL) information poster outlining the complaint process. Office Room: LPA observed a desk and file cabinets. Staff and resident files will be stored in this room and maintained in a locked manner to ensure confidentiality. Kitchen: Appliances and fixtures appeared clean and functional. There was sufficient dining and cookware to accommodate a maximum capacity of six (6) residents. Facility doesn’t have many perishable items nor fresh fruit because there are no residents at the time of the visit. Knives and other sharps will be stored in a locked drawer next to the dishwasher. Cleaning supplies, soaps and detergents are locked under-sink cabinets and shall be stored in areas separated from food supplies. There were no visible immediate hazards observed. Community phone and internet access is provided by the licensee to the residents. Continued from LIC 809-C Continued on LIC 809-C Garage/Laundry Area: Inside the garage, the LPA observed a washer and a dryer machine. Staff will assist residents with all laundry needs. Additionally, LPA observed an ample supply of emergency water and dried emergency food at the time of the visit. Surrounding Grounds: Garden and yard are easily accessible to residents, and they are sufficient in size, comfortable and appropriately equipped for outdoor use. Backyard: There was a shaded area with proper furniture for outdoor use. LPA observed one (1) self-closing and latching side gate. There is a locked shed in the backyard that holds gardening tools and extra supplies. LPA observed several gardening beds located in the backyard. LPA advised the licensee that if the gardening beds are used to grow vegetables, the produce shall not be served or provided to residents in care. Medical Area: Medications are stored in a locked kitchen pantry. There is a complete first aid kit inside a kitchen cabinet. Facility will properly document medication on the Centrally Store Medication and Destruction log (LIC 622) once facility receives first resident. Infection Control/Emergency Disaster Planning: The LPA reviewed the facility's infection control plan and the emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Continued on LIC 809-C Continued on LIC 809-C COMPONENT III ORIENTATION: A Component III Orientation was conducted with the Licensee during today's visit. The following needs to be completed/Photos sent to LPA prior to licensure:  Missing curtains in resident’s rooms and living room.  Missing posters This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. A copy of the Licensing Report was issued.the state’s words, verbatim · CDSS document, Feb 5, 2026