A Precious Care Villa

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Mariana Agban conducted a Case Management–Other visit at the above facility. Upon arrival, LPA met with facility staff and explained the purpose of the visit. LPA was informed that the facility was sold on 04/01/2026. It was further reported that Resident #1 (R1), Resident #2 (R2) and Resident #3 (R3) had passed away and that Resident #4 (R4) had been transferred from the facility. LPA contacted Administrator Oliver Domingo by telephone. The call was answered by Precious Domingo, the Administrator’s sister, who stated that Mr. Domingo was unavailable at the time of the call. LPA advised Ms. Domingo that, pursuant to Title 22 regulations, the Licensee/ Administrator is required to provide written notice to the department and to each resident or his or her legal representative of the licensee's intent to sell the facility at least 60 days prior to the transfer of property or business, or at the time that a bona fide offer is made, whichever period is longer. Additionally, LPA discussed the requirement to notify Community Care Licensing (CCL) within seven (7) days of a resident’s death. LPA informed Ms. Domingo that the facility should have reported the deaths of R1, R2, R3, as well as the transfer of R4, to CCL prior to the sale of the facility. LPA further advised that the licensee is required to surrender the facility license to the Department following the sale and cessation of operations under the existing license. LPA discussed the deficiencies identified during today’s visit and informed the facility representative that citations would be issued. An exit interview was conducted. Refer to LIC 809-D for deficiencies cited. A copy of this report was reviewed with facility staff.the state’s words, verbatim · CDSS document, Jun 17, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1568.068(a)(1) · Plan of correction due date: Jun 17, 2026

(1) The licensee shall provide written notice to the department and to each resident or legal representative of the licensee's intent to sell the facility at least 60 days prior to the transfer of property or business.. This requirement is not met as evidenced by: Based on information obtained, the licensee did not comply with the section cited above. Licensee had sold the facility on 04/01/26 and did not notify in writting CCL or facility residents which poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 17, 2026

Plan of correction: The Licensee is no longer operating the facility as of 04/01/26. POC is cleared. A new application was submitted to CAB for the new facility on 09/18/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(A) · Plan of correction due date: Jun 17, 2026

(a) (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence (A)Death of any resident from any cause regardless of where the death occurred. This requirement is not met as evidenced by: Based on information obtained, the licensee did not comply with the section cited above. Licensee / Administrator did not submit Death report for R1, R2 and R3 within 7 days. This poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 17, 2026

Plan of correction: POC is cleared. LPA obtained copies of Death Report during today's visit.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff Carmelita Terminez Aliga and explained the reason for the visit. Administrator was contacted by phone and LPA was informed that Administrator is out of town. LPA advised Administrator that when the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility. Staff Carmelita Terminez Aliga was designated to sign off the report. At approximately 11:30 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. Smoke alarm and carbon monoxide system were tested and observed not operational. The fire extinguisher is located in the kitchen and there were no indications of the service date or the purchase date. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: The facility has four (4) bedrooms, which only two (2) rooms are in use by residents, and the other two (2) are not occupied. All bedrooms are properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 109.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Temperature: Facility maintains a comfortable temperature of 75 degrees Fahrenheit.Common Areas: These included the living room and dining area. The common areas were properly furnished. (Continue on 809 C) Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. Laundry Area: is located in the garage, which is inaccessible to residents. Garage: LPA inspected the garage and observed that it is used only for storage. LPA observed additional fridge and storage boxes. Medications: Medication and Medication Records were review for proper documentation. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. LPA observed that Admission Agreement for Resident 3 was incomplete. Staff Files: LPA also conducted a file review of staff records and observed that there is no physical file for Staff #1 (S1) and Staff#2 (S2) is not associated to the facility and missing LIC 501 form. Staff was unable to provide LIC 500 as per Administrator is not update. Administrator advised that requested will be emailed to the LPA promptly. Exit interview conducted, Civil Penalty and other citations Issued, Appeal Right given and copy of this report delivered.the state’s words, verbatim · CDSS document, Jun 6, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mariana Agban conducted a case management- Deficiencies visit to the above facility. During file review, LPA observed that Staff#1 (S1) is missing required Licensing forms from the personnel file. In addition, Resident#1 (R1), Resident #2 (R2) and Resident #3 (R3) do not have a written hospice care plan as specified CCR 87633(a)(4) prior to the initiation of hospice services. Moreover, the Licensee did not notify the Department in writing within five (5) working days of the initiation of hospice for R1, R2 and R3 as specified in CCR 86632(d)(2) and stipulated on the approved Hospice Waiver. Lastly, Licensee have not provided a written request signed by each terminally ill resident or prospective resident upon admission, or by the resident's or prospective resident’s health care surrogate decision maker to allow for his or her acceptance or retention in the facility while receiving hospice services. Exit interview conducted, citations issued, appeal rights given and copy of this report delivered.the state’s words, verbatim · CDSS document, Jul 11, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Jul 25, 2024

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 record review, the licensee did not comply with the section cited above. S1 is missing forms LIC 501 , LIC 503, LIC 508. This poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 11, 2024

Plan of correction: Administrator will email LPA the requested documents by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87633(a)(4) · Plan of correction due date: Jul 25, 2024

Hospice Care of Terminally Ill Residents (a) The licensee shall... (4) A written hospice care plan ... is developed for each terminally ill resident ... by that resident’s hospice agency and agreed to by the licensee and the resident. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in three (03) out of four (04) residents which poses a Health, Safety, or Personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 11, 2024

Plan of correction: Administrator will email hospice care plans for R1, R2, and R3 to LPA by the POC date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87632(d)(1) · Plan of correction due date: Jul 25, 2024

A written request shall be signed by each terminally ill resident or prospective resident upon admission, or by the resident's or prospective resident’s health care surrogate decision maker to allow for his or her acceptance or retention in the facility while receiving hospice services. Based on record review, the licensee did not comply with the section cited above in three (03) out of four (04) residents which poses a Health, Safety, or Personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Jul 11, 2024

Plan of correction: Administrator will email LPA written requests signed by each terminally ill resident or prospective resident’s health care surrogate decision maker to allow for his or her acceptance or retention in the facility while receiving hospice services by the POC date

From the deficiency page — Deficiency type: Type B · Section cited: CCR87632(d)(2) · Plan of correction due date: Jul 25, 2024

The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. Based on record review, the licensee did not comply with the section cited above in three (03) out of four (04) residents which poses a Health, Safety, or Personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Jul 11, 2024

Plan of correction: Administrator will email LPA three (3) hospice notifications for R1, R2 and R3 by the POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Madonna Olila and explained the reason for the visit. At approximately 10:15 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. Smoke alarm/carbon monoxide system is hard wired and operating. The fire extinguisher is located in the kitchen. The purchase date August 13,2023. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: The facility has (5) bedrooms, with (1) room for staff; (2) private rooms, and (2) shared rooms. . All four (4) bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 106.5 and 107.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Temperature: Facility maintains a comfortable temperature of 77 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were properly furnished. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. Laundry Area: is located in the garage, which is inaccessible to residents. Medications: Medication and Medication Records were review for proper documentation. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records and observed many licensing forms are missing and or incomplete. Exit interview conducted, Citation Issued, Appeal Right given and copy of this report delivered.the state’s words, verbatim · CDSS document, May 20, 2024

Allegation investigated: Staff authorized Hospice care for resident without resident's consent.

This is an amended report of the prior investigation report delivered on 04/06/24. Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced visit to this facility. LPA met with Administrator Oliver Domingo and explained the reason for the visit. LPA conducted a physical plant tour, to ensure the health and safety of the residents are protected and the physical plant is in compliance with Title 22 Regulations. Based on information obtained and the appeal granted to the licenseee on June 26, 2024, the allegation that Staff authorized Hospice care for the resident without the resident's consent is deemed Unsubstantiated. Exit interview conducted and copy of this report delivered. Unsubstantiated Interview with Reporting Party(RP) revealed that R1 was discharged from the hospital on or around 04/01/23 without hospice order from the doctor. Interview with Assistant Administrator revealed that R1's day of Admission at the facility was on 04/01/23 with Hospice order already initiated by a referral agency. According to R1's doctor notes R1 was not placed on hospice care at discharge. However, it has been initiated and approved by the Assistant Administrator of the facility for R1 to receive hospice care. Based on information obtained, interviews and record reviews, the allegation deemed Substantiated at this time. Exit interview conducted, citations issued, appeal rights given and copy of this report delivered.the state’s words, verbatim · CDSS document, Apr 25, 2024 · control 31-AS-20230406143049

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.50(a)(3) · Plan of correction due date: Apr 25, 2024

Conduct inimical- (3) Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. This requirement is not evidenced by: Based on interviews and information obtained it was confirmed that R1 was placed on hospice care without authorization from their primary physician, nor their consent. This poses an immediate risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 25, 2024

Plan of correction: Within 24 hours, the Administrator and Administrator Assistant will submit a plan to address this section of the health and safety code. The plan must inlcude the vendor number, training topic and attendance log. Training and certification must be submitted to the licensing agency by May 9, 2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(16) · Plan of correction due date: Apr 26, 2024

87468.1 Personal Rights of Residents in All Facilities (a)(16) To receive or reject medical care or other services. This requirement is not evidenced by: Based on information obtained R1 was not able to accept or reject hospice care. This poses an immediate risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 25, 2024

Plan of correction: Within 24 hours, the Administrator and Administrator Assistant will submit a plan to address this section of the regulations. The plan must inlcude the vendor number, training topic and attendance log. Training and certification must be submitted to the licensing agency by May 9, 2024.

Type of visit: Case Management - Deficiencies

In conjunction to the complaint number 31-AS-20230406143049 Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted a case management- Deficiencies visit. During the complaint investigation, it was confirmed that Licensee failed to submit a death report for Resident 1(R1) to CCL. LPAs conducted a file review and didn't observe death report on file. Deficiencies Cited. Exit Interview Conducted. Report Issuedthe state’s words, verbatim · CDSS document, Apr 25, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80061(b) · Plan of correction due date: May 9, 2024

80061(b) Reporting Requirements. Upon the occurrence…a report shall be made to the licensing agency..., a written report ...within seven days following the occurrence of such event. This requirement was not met as evidence by: Based on file document review, the Licensee did not comply with the section cited above. Lincesee didn't submit a death report for R1 since they passed away on or around of June or July 2023. This poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Apr 25, 2024

Plan of correction: The Administrator will conduct in service training reviewing the regulation section about reporting requirements. The Administrator will provide all training materials and signatures of all staff that have attended the training by the POC due date. Licensee will also submit the Death Report for R1.