Affordable Board and Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced One (1) year Required visit at this facility. LPA met with the administrator Vilbert Keshishi and explained the purpose of this visit. A tour of the physical plant was conducted at 9:18 AM and the following was observed: The facility has one main entrance being used, screening station is located immediately upon entrance and had a table equipped with hand sanitizer, gloves, mask and sign in sheet. The facility has an approved mitigation and Infection plan on file. The facility is a single storey building and has four (4) bedrooms and two (2) bathrooms. An additional bedroom and one (1) bathroom is designated for staff use. Fire cleared for six (6) non-ambulatory residents, one (1) of which maybe bedridden on Room #1. Hospice waiver for six (6) residents. Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 74°F. The dual smoke/carbon monoxide alarm are hardwired and interconnected and observed to be operational. There is a Fire extinguisher located in the kitchen and observed to be last bought on 02/08/26. (continued on LIC 809-C) (continued from LIC 809) The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in the kitchen drawer and inaccessible to residents. Laundry area is located in the garage. Laundry detergent, cleaning solutions and other toxins are observed to be locked inside the garage. The Bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was checked and measured at 115.7°F. Towels and washcloths are not shared. There were enough clean linen available in stock at the cabinet. Medications: LPA observed that the medication are kept in the cabinet in the kitchen are a and was observed to be locked and inaccessible to residents. There was a complete first aid kit located on top of the medication cabinet. Garage: The garage has access from inside the facility and also being used as frozen and emergency food and other supplies storage. The Backyard had a covered shaded area for clients with outdoor furniture. There is no body of water at the facility. Client records. All six (6) clients records were reviewed. Clients record appeared to be complete and current. Staff records were also reviewed. Three (3) staff records were reviewed, they all have criminal record clearances and associated to this facility. Current training and first aid observed for staff on duty. Administrator's certificate was observed to be current. Disaster drill was last conducted on 04/01/26. Required posting observed in facility (complaint hot line poster, personal rights, etc). Exit interview conducted. Copy of the report issued.the state’s words, verbatim · CDSS document, Apr 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced One (1) year Required visit at this facility. LPA met with the administrator Vilbert Keshishi and explained the purpose of this visit. A tour of the physical plant was conducted at 9:46 AM and the following was observed: The facility has one main entrance being used, the main door has required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) are posted on the door. The PPE screening station is located immediately upon entrance and had a table equipped with sufficient PPE readily accessible, a thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit. Visitors are required to wear mask. The facility has an approved mitigation plan on file. The facility is a single storey building and has four (4) bedrooms and two (2) bathrooms. An additional bedroom and one (1) bathroom is designated for staff use. Fire cleared for six (6) non-ambulatory residents, one (1) of which maybe bedridden on Room #1. Hospice waiver for six (6) residents. Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 73°F. The dual smoke/carbon monoxide alarm are hardwired and interconnected and observed to be operational. There is a Fire extinguisher is located in the kitchen and observed to be last bought on 02/05/25. (continued on LIC 809-C) (continued from LIC 809) The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in the kitchen drawer and inaccessible to residents. Laundry area is located in the garage. Laundry detergent, cleaning solutions and other toxins are observed to be locked inside the garage. The Bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was checked and measured at 111.4°F. Towels and washcloths are not shared. There were enough clean linen available in stock at the cabinet. Medications: LPA observed that the medication are kept in the cabinet in the kitchen are a and was observed to be locked and inaccessible to residents. There was a complete first aid kit located on top of the medication cabinet. Garage: The garage has access from inside the facility and also being used as frozen and emergency food and other supplies storage. The Backyard had a covered shaded area for clients with outdoor furniture. There is no body of water at the facility. Client records. All six (6) clients records were reviewed. Clients record appeared to be complete and current. Staff records were also reviewed. Three (3) staff records were reviewed, they all have criminal record clearances and associated to this facility. Current training and first aid observed for staff on duty. Administrator's certificate was observed to be current. Disaster drill was last conducted on 01/03/25. Required posting observed in facility (complaint hot line poster, personal rights, etc). Exit interview conducted. Copy of the report issued.the state’s words, verbatim · CDSS document, Mar 26, 2025

Allegation investigated: . Staff does not ensure that resident receive adequate wound care 2. Staff left resident soiled in feces 3. Staff are severely restricting residents’ visitation

Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Vilbert Keshishi, and informed him the purpose of the visit, which is to finalize the above complaint allegations. On October 13, 2022, the Woodland Hills Regional South Adult and Senior Care Office, received a complaint, for the allegations mentioned above. On August 31, 2021, the complaint was referred to the Community Care Licensing Division’s (CCLD’s) Investigations Branch (IB), and assigned to Investigator Jose Santana, to investigate and determine the finding for allegation # 1. LPA Tuesday Cabiness, conducted a subsequent visit, interviewed staff and residents, pertaining to allegation # 2 and 3. The following was determined: Allegation # 1: “Staff does not ensure that resident receive adequate wound care”. On October 14, 2022, from 930am to 12pm, former LPA Wendell Smith, conducted the initial complaint visit, as well as conducted a physical plant inspection, reviewed, and obtained resident medical records, and interviewed staff. Investigator Santana conducted interviews, obtained, and reviewed facility documents and medical records, pertaining to allegation #1 on various dates, from approximately October 2022 through November 2022. The following is a Unsubstantiated summary of the IB investigation and it’s finding of the allegation. Resident #1 (R1) was admitted to the facility on 09/26/2022 and already being regularly treated by hospice nurses and wound care physicians prior to being admitted. Once the facility retained R1, the wound care services continued for R1’s wound, and the Administrator, including staff, treated the wound in between skilled nurses’ visits and per hospice care instructions. Investigator Santana reported that the complainant was under the impression (R1) developed the wound while in the care of the facility, and that the facility was not allowed to retain or admit (R1) with the wound. Further information by Investigator Santana revealed, the facility met the necessary requirements to retain and treat R1, therefore, based on the investigation conducted by IB investigator Santana, and all information obtained, through interviews and documentation, the allegation is deemed UNSUBSTANTIATED at this time. Allegation # 2: “Staff left resident soiled in feces”. On October 14, 2022, from 930am to 12pm, former LPA Wendell Smith, conducted the initial complaint visit, as well as conducted a physical plant inspection, reviewed, and obtained resident medical records, and interviewed staff. LPA T. Cabiness reviewed facility documents, resident and medical records, and other documentation pertaining to allegation # 2 on various dates and times, in October 2022, December 2022, July 2023, and December 2023, and May 2024. On 05/24/2024, LPA T. Cabiness conducted a subsequent visit and interviewed staff, as well as obtained additional documentation. From the information obtained, resident # 1 (R1) was diagnosed a severe medical condition that caused diarrhea. It was reported to LPA that staff had to change R1’s diarrhea several times throughout the day. On the day in question, pertaining to the allegation, although it was reported, R1’s diaper was soiled with feces, it was due to R1’s medical condition, and not by the negligence of staff. Therefore, based on interviews, and documentation, there is insufficient evidence to prove the allegation, and it’s Unsubstantiated at this time. Allegation # 3: “Staff are severely restricting residents’ visitation”. On October 14, 2022, from 930am to 12pm, former LPA Wendell Smith, conducted the initial complaint visit, as well as conducted a physical plant inspection, reviewed, and obtained resident medical records, and interviewed staff. LPA T. Cabiness reviewed facility documents, resident and medical records, and other documentation pertaining to allegation # 3, on various dates and times, in October 2022, December 2022, July 2023, and December 2023, and May 2024. On 05/24/2024, LPA T. Cabiness conducted a subsequent visit and interviewed staff, as well as obtained additional documentation. From the information obtained, R1 was scheduled for a home health nurse to visit and provide services. On the day in question, (2) home health nurses showed up to the facility at the same time. There was a schedule conflict and the Administrator requested (1) nurse to provide the services for R1. Therefore, based on interviews, the allegation is Unsubstantiated at this time. Exit interview and copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Jul 8, 2024 · control 31-AS-20221013141941

Allegation investigated: . Resident sustained pressure injuries while in care 2.Staff did not change resident timely

Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Vilbert Keshishi to deliver the final findings of the allegations mentioned above. The following was determined: Allegation # 1: It was alleged that resident sustained pressure injuries while in care. On 08/26/2022 from 930am to 11am, and during today's visit, LPA conducted interviews and reviewed resident records. From the information obtained, it was revealed to LPA, that resident #1 (R1) had developed an eye infection and prescribed antibiotics. R1 developed a severe case of diarrhea that lasted over a series of months, which eventually resulted in R1 being admitted to the hospital several times and diagnosed with a bacterial infection. R1 was admitted to the facility with the infection, and staff had to continuously change R1’s diaper. Interviews revealed that the infection, caused R1’s skin to become sensitive and frail. Although it was reported R1 sustained pressure injures while in care, LPA does not have enough evidence to corroborate the allegation, therefore based on interviews, it’s Unsubstantiated at this time. Unsubstantiated Allegation # 2: It was alleged that staff did not change resident timely. On 08/26/2022 from 930am to 11am, and during today's visit, LPA conducted interviews and resident records. From the information obtained, it was revealed to LPA, that R1 had developed a severe bacterial infection that caused severe diarrhea. Prior to being admitted to the facility, R1 was retained with the infection. Interviews also revealed that the infection, caused R1 to be hospitalized several times and caused R1 to have diaper changed hourly. Although it was reported, staff did not change resident timely, LPA does not have enough evidence to corroborate the allegation, therefore based on interviews, it’s Unsubstantiated at this time. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, May 14, 2024 · control 31-AS-20220822130646

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced One (1) year Required visit at this facility. LPA met with the administrator Vilbert Keshishi and explained the purpose of this visit. A tour of the physical plant was conducted at 12:46 PM and the following was observed: The facility has one main entrance being used, the main door has required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) are posted on the door. The PPE screening station is located immediately upon entrance and had a table equipped with sufficient PPE readily accessible, a thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit. Visitors are required to wear mask. The facility has an approved mitigation plan on file. The facility is a single storey building and has four (4) bedrooms and two (2) bathrooms. An additional bedroom and one (1) bathroom is designated for staff use. Fire cleared for six (6) non-ambulatory residents, one (1) of which maybe bedridden on Room #1. Hospice waiver for six (6) residents. Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 73°F. The dual smoke/carbon monoxide alarm are hardwired and interconnected and observed to be operational. There is a Fire extinguisher is located in the kitchen and observed to be last bought on 04/27/24. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. (continued on LIC 809-C) (continued from LIC 809) Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in the kitchen drawer and inaccessible to residents. Laundry area is located in the garage. Laundry detergent, cleaning solutions and other toxins are observed to be locked inside the garage. The Bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was checked and measured at 115.3°F. Towels and washcloths are not shared. There were enough clean linen available in stock at the cabinet. Medications: LPA observed that the medication are kept in the cabinet in the kitchen are a and was observed to be locked and inaccessible to residents. There was a complete first aid kit located on top of the medication cabinet. Garage: The garage has access from inside the facility and also being used as frozen and emergency food and other supplies storage. The Backyard had a covered shaded area for clients with outdoor furniture. There is no body of water at the facility. Client records. All five (5) client records were reviewed. Clients record appeared to be complete and current. Staff records were also reviewed. Three (3) staff records were reviewed, they all have criminal record clearances and associated to this facility. Current training and first aid observed for staff on duty. Administrator's certificate was observed to be current. Disaster drill was last conducted on 04/01/24. Required posting observed in facility (complaint hot line poster, personal rights, etc). Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, Apr 28, 2024

Allegation investigated: . Licensee did not meet resident's needs resulting in hospitalized for UTI and dehydration 2. Licensee did not observe change in condition of resident 3. Licensee did not obtain medical care for resident in care 4. Resident lost significant amount of weight 5. Licensee was unable to meet resident's care needs 6. Licensee did not assist with resident's hygiene needs

Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Vilbert to deliver the final findings of the allegations mentioned above. The following was determined: Allegation # 1: Licensee did not meet resident’s needs resulting in hospitalized for UTI and dehydration. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. It was reported to LPA, that resident # 1 (R1) was to be admitted to the facility for only (2) weeks, until R1’s husband returned from out of town. R1’s medical condition and diagnosis was dementia, with a fully contracted body. R1’s total care was depended on staff provided all ADL’s, including feeding R1. It was reported to LPA that R1 was admitted to the facility with a foul odor from R1’s urine. Staff attempted to contact R1’s husband to inform him of the smell but was not successful. Although it was reported R1 had an UTI, it was reported R1’s UTI was due to R1’s progression with R1’s diagnosed medical condition. Through all the information obtained, LPA does not have enough evidence to prove R1 was dehydrated and had an UTI Unsubstantiated during the temporary stay at the facility. Therefore, based on interviews and documentation, the allegation is Unsubstantiated at this time. Allegation # 2: Licensee did not observe change in condition of resident. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. It was reported to LPA through interviews, R1 was admitted to the facility with a fully contracted body and had a foul odor. R1 stayed at the facility for (2) weeks, and staff took care of R1 to the best of their ability and LPA does not have enough evidence to prove otherwise, therefore based on interviews and documentation received, the allegation is Unsubstantiated at this time. Allegation # 3: Licensee did not obtain medical care for resident in care. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. Prior to R1 being admitted to the facility, the Administrator requested R1 to be taken to urgent care. R1 was taken to urgent care before being admitted. Due to R1’s medical condition, staff reported R1 had a foul odor from R1’s urine. The Administrator stated, that because R1’s was admitted for a temporary stay, there was no change in R1’s medical condition when picked up from husband. The Administrator and wife are in the medical field, and have medical knowledge and training, and both did not observe that R1 needed medication attention. Therefore, LPA does not have enough evidence to prove facility did not obtain medical care for R1. Based on interviews, the allegation is Unsubstantiated at this time. Allegation # 4: Resident lost significant amount of weight. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. It was reported to LPA R1 lost a significant amount of weight during the (2) week stay at the facility. It was also reported, that when R1 was admitted, R1 was frail and had very thin skin. There was no documentation provided to the Administrator of R1’s weight when R1 was admitted. Although it was reported and alleged that R1 lost an enormous amount of weight, LPA does not have enough evidence to prove the allegation, therefore, based on interviews and documentation, it is Unsubstantiated at this time. Allegation # 5: Licensee was unable to meet resident's care needs. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. Although it was reported that the facility did not provide adequate care for R1, and R1 had to be hospitalized, through interviews, and observations, LPA does not have enough evidence to prove the facility is unable to meet resident’s needs. LPA has observed during various times and visits, residents and facility was clean. LPA has also observed residents eating and staff cooking meals. Therefore based on interviews and observations, the allegation is Unsubstantiated at this time. Allegation # 6: Licensee did not assist with resident's hygiene needs. Licensee was unable to meet resident's care needs. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. It was alleged that R1 was dirty and filthy when picked up by R1’s husband. R1 was taken to the hospital and was admitted for (2) days. There was no documentation provided for R1 from the hospital, alleging R1’s appearance when admitted to the hospital. Interviews reveal, residents are sponge bathed once or twice a week, including R1, during R1’s temporary stay. LPA has observed during many visits, residents were clean and staff providing appropriate care for residents. Therefore, LPA does not have enough evidence to prove facility did not assist with R1’s hygiene needs, and based on interviews and observations, the allegation is Unsubstantiated at this time. Exit interview and copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Feb 13, 2024 · control 31-AS-20211012105006

Allegation investigated: Staff hit resident

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegation. LPA met with administrator Vilbert Keshishi and explained the reason for the visit. LPA conducted physical plant tour at 9:44 AM, requested copies of facility documents relevant to the investigation at 10:05 AM and interviewed staff, resident and resident family between 10:30 AM to 1:30 PM. It was alleged that Resident #1 (R1) was hit by a staff in the face. LPA's record review today at 11:30 AM revealed that R1 has a diagnosis of Dementia. LPA's interview with R1 today at 12:02 PM revealed that R1 was incoherent and seemed confused and was not able to answer simple questions. LPA's interview with Resident #2 (R2) who is the room mate of R1 for over a year, however, revealed that no one hit R1 nor R2 at anytime during their stay at the facility. LPA's interview with two (2) staff and administrator revealed that all of the staff interviewed denied hitting any resident at the facility at any time. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with R1's family member (FM) today at 12:45 PM revealed that FM visit R1 almost everyday, sometimes multiple times a day. FM stated that it may or could have happened but did not witness any staff hitting R1 or any resident during FM's visit. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Nov 16, 2023 · control 31-AS-20231114122645