Lovely Community Healthcare 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:16 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator / Licensee Representative, Cilva Toume and Co-Administrator Vana Barberis arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and staff / Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: This includes three (3) living rooms, and a dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 12:21 p.m., hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 05/05/2025. The emergency exiting plans/sketch are posted. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 10/03/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened, and non-functional. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. INTERVIEWS: Starting at 10:02 a.m. and throughout the visit two (2) staff and two (2) resident interviews were conducted. Staff interviews revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are eight (8) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and two (2) staff rooms. The staff rooms are kept locked at all times and observed to be occupied by staff. Six (6) out of six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are three (3) total restrooms. One (1) is designated as a shared / common resident restroom, and two (2) are designated as a private resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 109.8- 110.8 degrees Fahrenheit, all within the required range. LPA observed storage space closets in the hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 110.8 degrees Fahrenheit. Cleaning supplies and other chemicals are kept in the laundry room locked and inaccessible to residents in care. LAUNDRY ROOM: LPA observed the locked laundry room that is the direct access to the staff rooms. Laundry room is adjacent to the staff rooms. Laundry room has a washer and dryer and cleaning supplies. The laundry room remains locked at all times. LPA observed emergency food and water, personal protection equipment (PPE) , incontinent supplies, and two (2) extra refrigerators/freezer that were checked for proper labels and expiration dates. BACKYARD: The entire property is fenced. The backyard has a patio area with an umbrella for shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. There are two (2) locked storage sheds in the back yard inaccessible to residents. Only one (1) pathway is used as an emergency exit which was free of obstructions at the time of the visit. There were two (2) outdoor refrigerators. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... RECORDS: Record review began at approx. 10:43 a.m. and resumed at 11:34 a.m. Personnel Records were reviewed beginning at 10:43 a.m. five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. Resident Records: were reviewed beginning at 11:34 a.m. six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 12:46 p.m. Medications are centrally stored and locked in a cabinet in the kitchen adjacent to the dining room. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. LPA observed the first aid supplies to be complete, including a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500- facility roster, LIC 9020A- Resident roster and copy of the current Limited Liability insurance. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report reviewed and provided.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent case management visit to deliver findings for the death investigation initiated on 02/27/2024 case management visit. LPA met with Administrator Cilva Toume and Assistant Administrator Vana Barberis and explained the reason for the visit. On 02/26/2024, the Department received a self-reported death report from the facility. The death report stated that on 02/20/2024, Resident #1 (R1) was seen choking on their saliva by the caregiver on duty. The caregiver immediately called 911 and began CPR. The Department referred the case to the Community Care Licensing (CCL) Investigations Branch (IB). The case was assigned to Investigator Laura Garcia to conduct the investigation. On 02/27/2024, from 3:15pm to 6:45pm, Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management – Incident visit to the above facility. LPA Cortez met with the administrator Cilva Toume and explained the reason for the visit was to follow up on the self-reported death report received on 02/26/2024. The report pertained to the 02/20/2024 death of Resident #1 (R1). During the visit, the LPA conducted interviews with staff and R1's resident representative, conducted a brief tour of the facility, and obtained copies of pertinent documents. The LPA informed the administrator that the incident was referred to the Community Care Licensing (CCL) Investigations Branch (IB) for review and further investigation was required prior to issuing findings. Report will continue on LIC809-C, 2nd page. On 03/04/2024, at approximately 12:00pm, CCL IB Investigator Garcia conducted an interview with the administrator; on 03/07/2024, from approximately 11:45am to 2:30pm, with administrator, staff, and resident; on 04/15/2024, at approximately 12:00pm, with R & G Home Health Care Services medical staff; and on 04/25/2024, at approximately 11:35am, with R1’s physician Dr. Gehlani. In addition, Investigator Garcia requested Ventura County Sheriff’s Department and Emergency Medical Services reports. To date, no reports have been obtained. A review of R1’s facility file documents indicate that R1 was admitted to the facility on 08/12/2022. R1’s Physician Report, dated 08/24/2023, lists diagnosis as HTN, HLD, and Hypothyroid. The report also lists Mild Cognitive Impairment (MCI), needs assistance with self-care, except for feeding, disoriented, confused, able to follow instructions and able to communicate needs. The investigation revealed that on 02/13/2024, R1 tested positive for COVID-19. Due to the diagnosis with COVID-19, R1’s physician, prescribed a nebulizer which consisted of 15-to-20-minute treatments. R & G Home Health Services conducted training with staff and R1 and visited R1 three times per week. It was noted in the home health notes that R1 was able to remove the nebulizer mask by their self. On 02/20/2024, at approximately 5:30pm, facility staff indicated that while R1 was receiving the nebulizer treatment, they were in direct line of sight of R1 and as soon as they noticed R1 was having trouble breathing, they immediately dialed 911 and performed CPR until paramedics arrived on scene. The paramedics arrived and continued with CPR measures. Per the administrator, the paramedics continued CPR measures for an additional 40 minutes until R1’s passing. R1’s certificate of death from Ventura County Registrar and Recorder office noted R1’s primary cause of death, was due to cardiac arrest and hypertension. COVID-19 was also noted as a significant contributing factor to R1’s death. During the course of the investigation, interviews were conducted with facility staff members, residents, R1’s physician Dr. Ghelani, and R & G Home Health Care Services medical staff. The home health clinical notes were also obtained and reviewed. R1’s physician and home health nurses denied observing neglect or lack of care by facility staff members. The home health agency was involved with the continuous care of R1. Report will continue on LIC809-C,3rd page. Staff described R1 as able to express their needs, despite age-related cognitive decline. R1 had the capability of self-administering the nebulizer treatment and training had been previously provided to staff on how to assist with R1's treatment and condition. Dr. Ghelani and the home health staff confirmed that R1 did not require direct supervision or one-to-one care during treatments. R1 had last been seen by the home health nurse on 02/19/2024 and there were no signs of respiratory distress noted. Based on the information obtained, there is insufficient evidence to support neglect/ lack of care leading to the death of R1. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview, copy of report given.the state’s words, verbatim · CDSS document, May 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced at 09:32AM to conduct an annual inspection. LPA was greeted by staff. The LPA communicated with the Administrator/Licensee Cilva Toume via telephone and explained the reason for the visit. Licensee Cilva Toume arrived at 10:12AM. Entrance interview conducted. Beginning at 10:26AM, the LPA along with the Licensee and facility Designee, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS: The facility contains 6 (six) private residents’ bedrooms and 2 (two) staff bedrooms. Every residents’ room has a direct exit to the outdoors. Staff rooms remain locked. All resident rooms were observed to contain appropriate furnishings, linens and lighting. RESTROOMS: Facility has one common bathroom and private bathrooms in room #1 and #5. Bathrooms are equipped with grab bars and non-skid mats in the shower area for resident use. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in the common resident restroom and measured within the required range after a slight adjustment. COMMON AREAS: The living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is not in operation and is blocked by the television cabinet and the television. The facility maintained a comfortable temperature throughout the visit. Hardwired smoke and carbon monoxide detectors were tested and were operational. One fire extinguisher was fully charged and purchased on 05/23/2024. The LPA observed required postings by the entrance of the facility. KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Report Continued on LIC 809-C OUTDOOR AREA/GARAGE: The backyard has an outdoor area equipped with furniture for resident use. There is a side gate for resident use which is single-latched. No bodies of water were noted. Passageway was clear and free of hazards. The garage is attached to the home and was observed to be locked. The washer and dryer are located inside the garage. Cleaning supplies were located inside the garage and the staff rooms were observed as part of the converted garage, which Licensee indicated is permitted. RECORDS: Records review began at 11:25AM. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Residents and staff recorsd are kept in a locked dining area cabinet. MEDICATIONS: Medications review began at 01:36PM. Medications are centrally stored and locked in a cabinet in the dining area; medications are labeled and checked for expiration dates. LPA reviewed medications for 2 (two) residents. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and Emergency Disaster Plan. Both documents were observed to be complete and updated annually as required. Emergency drills are conducted quarterly, with the last drill conducted in September 2024. INTERVIEWS: Throughout the visit, LPA interviewed staff and residents. No concerns were noted during the interviews. No deficiencies cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 21, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management – Incident visit to the above facility. The LPA met with Administrator Cilva Toume and explained the reason for the visit. Entrance interview. The reason for today's inspection is to follow up on a self-reported death report received on 02/26/2024. The report pertains to the death of Resident #1 (R1). Per the information received, the circumstances surrounding the death of Resident #1 on 2/20//24 may be questionable and needs to be investigated. Emergency services and law enforcement were called to the facility on the day of Resident #1's death. During today's visit, the LPA conducted interviews with staff, R1's responsible party, conducted a brief tour of the facility and obtained copies of pertinent documents. This incident was referred to Community Care Licensing Investigations Branch (IB) for review. Further investigation is required prior to issuing findings. An investigator or the LPA will return at a later date. Exit interview conducted. A copy of the report was issued to the Administrator Cilva Tourne.the state’s words, verbatim · CDSS document, Feb 27, 2024

Allegation investigated: Facility is not free from hazards.

Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent visit to deliver the findings pertaining to the allegations listed above. The LPA arrived and was greeted by staff. Staff contacted the administrator via phone. The LPA spoke with the administrator Cilva Toume and explained the reason for the visit. LPA read the report to the Administrator on the phone, and allowed staff representative to sign the reports. On 01/26/2024, the Department received a complaint from a Reporting Party (RP) who observed and expressed concern about a hazard outdoors, in the side patio area. The RP observed two(2) refrigerators and or freezers on the side of the house plugged into a "makeshift electrical box". On 01/29/2024, Licensing Program Analyst (LPA) Sandra Urena conducted an initial 10-day visit to investigate the allegation listed above. The LPA and the administrator conducted a tour of the facility. The tour of the outside physical plant revealed that there is an outside electrical line that runs from an electrical box attached to the property to the additional outlet plug. Continues on LIC 9099C... Substantiated The administrator stated that the electrical cord was present since they open the facility in 2017. The administrator stated that the Fire Inspector Richard Martinez from the Ventura Fire Department will conduct an inspection on 01/30/2024 to ensure that the electrical box is withing compliance with the VFD. On 02/05/2024, at approximately 2:21p.m., LPA Urena spoke with the VFDI, Richard Martinez about the inspection conducted on 01/30/2024. The VFDI stated that the electrical box wiring was not up to code during the FI inspection. The wiring was open to the elements. Based on the information received through the Ventura Fire Department Inspector, the allegation that the facility was not free safe of hazards is deemed Substantiated at this time. Pursuant to Title 22 Regulations, deficiencies were cited (refer to LIC 9099-D). Citations were issued. Exit interview conducted, a copy of the report, and Appeal Rights was issued.the state’s words, verbatim · CDSS document, Feb 22, 2024 · control 29-AS-20240126134243

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87203 · Plan of correction due date: Feb 22, 2024

CCR-87203- Operating Requirements All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on the information obtained through observation and information received through the VFDI, the licensee did not comply in the section cited above, as the electrical box found outside the facility had wires that were exposed, which may pose a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 22, 2024

Plan of correction: The exposed wiring has been corrected at the time of this report.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced annual inspection. LPA was greeted by staff and the LPA explained the reason for the visit. The LPA communicated with the Administrator Cilva Toume and explained the reason for the visit. The Administrator stated that she would arrive within 20 minutes to the facility. At 11:30 a.m., the LPA and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: At 11: 40 a.m. the living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is not in operation and is blocked by the television cabinet and the television. The facility is maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. One fire extinguisher was fully charged and was last purchased on 06/13/2023. The LPA observed required postings by the entrance of the facility. BEDROOMS: At 11:45 a.m. it was observed that the facility has six private residents’ bedrooms and two staff bedrooms. Every residents’ room has a direct exit to the yard. The LPA and Administrator observed that in bedroom #1, the door that leads to the bedroom’s private patio area was open. This patio has a gate that leads to the front of the house, and access to the street. The gate has a latch; however, the gate does not have a signal system to alert the staff if the resident opens the gate. The private patio area was observed to have old furniture (two mattresses), a tank of propane gas, which the administrator stated that it was empty, and two folding chairs. During the inspection, staff removed all the items from the private patio. Additionally, the rooms’ closet was observed to have a mattress inside leaning against the closet’s wall. At the time of the visit, bedroom #2 and bedroom #3 sound systems were not operational, however during the visit the administrator put in the new batteries. Signal system was tested and was operational when LPA checked bedroom #2. Staff was working on signal system for bedroom # 3. Bedrooms were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: Facility has one common bathroom and private bathrooms in room#1 and #5. Bathrooms are equipped with grab bars and non-skid mats in the shower area for residents' use. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperatures measured as follows: Bathroom in bedroom #1 at 127.4 degrees Fahrenheit, bathroom in bedroom #5 at 124.6 degrees Fahrenheit. KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured at 126.6 degrees Fahrenheit. OUTDOOR AREA/GARAGE: The backyard has an outdoor area equipped with furniture for client use. The shade/canopy is worn out and torn. Shade needs to be provided for residents. There is a side gate for client use and is single-latched. No bodies of water noted. The emergency passageway had three bicycles standing in the passageway; the administrator moved the bicycles out of the way during the inspection. Three (3) paint cans, and two (2) bottles of bug pesticide were observed to be accessible to residents in an open metal cabinet located in the right-hand side passageway outdoor area. A bag of construction material, which was clearly labeled as ‘Danger: Causes severe skinburns’… was observed to be open and accessible to residents in an unlocked wood cabinet located in the right-hand side passageway outdoor area. All dangerous materials were removed during the inspection. The garage is attached to the home. The door was locked at the time of the inspection. The washer and dryer are located inside the garage. Cleaning supplies were located inside the garage. RECORDS: Records review began at 1:10 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. At 1:50 p.m. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Residents and staff record are kept in a locked kitchen cabinet. MEDICATIONS: Medications review began at 2:15 p.m. Medications are centrally stored and locked in a cabinet in the kitchen area; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster Deficiencies were cited at this time. Exit interview conducted. A copy of the report, and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Nov 30, 2023