Angels of the Valley Board & Care

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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 Yana Diaz and explained the reason for the visit. At approximately 09:30 am, with the assistance of the Administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms were tested, and they function properly. The carbon monoxide detector was tested, and it functions properly. The fire extinguisher is located in the main hallway. The charge date February,2026 . 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: There were four (4) bedrooms designated for residents' use. All four bedrooms in use by residents were properly furnished with appropriate bedding and linens and with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. The hot water temperature was measured from the bathroom sink at 108.9 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: LPA observed that the facility is still under construction in the backyard. There were no visible immediate hazards. (Continue on 809C) The gate at the side of the home was checked to ensure no locks were installed, and that exits and passageways were clear for emergency evacuation. The laundry area is located in the garage, which is inaccessible to residents. Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. Medications: Medication and Medication Records were reviewed for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Mar 16, 2026

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 Yana Diaz and explained the reason for the visit. At approximately 09:30 am, with the assistance of staff#2 (S2), LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms were tested, and they function properly. The carbon monoxide detector was tested, and it functions properly. The fire extinguisher is located in the hallway. The purchase date is Feb 5, 2025. Temperature: Facility maintains a comfortable temperature of 77 degrees Fahrenheit. 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: There were four (4) bedrooms designated for residents' use. All four bedrooms in use by residents were properly furnished with appropriate bedding and linens and with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. The hot water temperature was measured from the bathroom sink at 108.9 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located in the garage, which is inaccessible to residents. Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. Medications: Medication and Medication Records were reviewed for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Mar 4, 2025

Allegation investigated: Facility retains resident(s) with prohibited health condition(s) Over-occupancy in Resident bedroom(s) Facility not kept in a safe condition

On 09/24/2024 at 10:00 am Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced subsequent visit to this facility to investigate the above stated allegations. LPA was greeted by staff and was granted access to the facility. LPA spoke to the Administrator Yana Diaz and explained the reason for the visit. On 06/12/2023, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding the allegations mentioned above. On 06/20/2023, LPA Mariana Agban and Licensing Program Manager (LPM) Eva Miller initiated the complaint visit. LPA Agban and LPM Miller conducted a tour of the facility and obtained copies of pertinent information. LPA Agban also conducted an interview with the Administrator. LPA Casillas reviewed documents collected by LPA Agban. LPA Casillas also reviewed interviews conducted by LPA Agban. Continued on LIC9099-C Unsubstantiated At 10:00 AM LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were conducted from 10:00 am to 12:30 pm. LPA requested and obtained copies of updated resident roster, updated LIC 500, Administrator Certificate and Liability Insurance. LPA requested copies of Physician Reports for all residents, and any other information pertaining to the investigation. LPA Casillas conducted interviews with Administrator, two (2) staff and six (6) residents out of six (6) that were present at the facility at the time of the visit. Allegation #1 Facility retains resident(s) with prohibited health condition(s). It is alleged that facility retains resident(s) with prohibited health condition(s). Regarding this allegation, it is reported that on an undisclosed date, a medical emergency call was made, and emergency personnel were dispatched to the facility where it was observed that a person with bedside suctioning equipment, a dislodged nasogastric tube, and a gastrostomy tube, was residing and receiving care in the facility. Interview with the Administrator revealed that the person in question was in fact an adult relative of the Administrator’s that resided in the home, who was fingerprint cleared, and not a Resident. The Administrator states that the relative has since passed and is no longer at the facility. The Administrator stated that the facility is their primary home, however there is a separate area where the Residents have their own living quarters. LPA interviewed staff that confirmed that Administrator lives in the facility with their relative and that living quarters are kept separate for both staff and residents. Furthermore, it was confirmed by staff that the person in question was not a facility Resident, but a relative that lived in the home. LPA interviewed Residents present in the facility and they also confirm that the persons living in the staff room are staff and relatives of the Administrator. LPA reviewed documentation and the person in question is/was listed as a cleared adult allowed to be in the home. LPA also reviewed all Resident files and none of the Residents currently residing in the facility have a prohibited health condition, therefore based on observations, record review, and interviews, this allegation is deemed Unsubstantiated. Continued on LIC9099-C Allegation #2 Over-occupancy in Resident bedroom(s). It is alleged that there is over-occupancy in Resident bedroom(s). Regarding this allegation, it is reported that there are three (3) beds being used in the primary room. Interview with the Administrator revealed that the room in question is the staff room, and no Residents have access to that room. Administrator stated that the three beds are for personal use and are not all used at the same time. Interviews with staff confirmed that the room with three (3) beds is the staff room and that the beds are for personal use. Interview with Residents revealed that Residents do not have access to the staff room therefore they do not know what is contained in that room. During LPA tour it was noted that staff room is labeled “Staff Room Only”, it was locked and inaccessible to Residents. LPA also observed that all Resident rooms are adequately being used for the number of beds/residents allowed per the fire clearance. Based on observations, file reviews and interviews this allegation is deemed Unsubstantiated. Allegation #3 Facility not kept in a safe condition. It is alleged that the facility is not kept in a safe condition. Regarding this allegation, it is reported that there was an excessive amount of storage in the primary bedroom and that there was an excessive amount of extension cords that were running up the wall causing a fire hazard. Interview with the Administrator revealed that the room in question is the staff bedroom where all the belongings are for personal staff use. Administrator states that the extension cords that were in use at the time of the complaint were used for medical equipment that was for the relative that was being cared for by the Administrator, and that all the equipment has since been removed. Interviews with staff confirmed that the staff bedroom is used for staff personal use only and that Residents do not have access to that room as it always remains inaccessible. During LPA’s tour of the facility, it was observed that all Resident rooms as well as areas throughout the facility were clean and clear of clutter. LPA was granted access to the staff room where it was observed that the room was clean and free of clutter as well as free of excessive extension cords. LPA did not observe any extension cords being used in Resident rooms nor was there an excessive amount of storage throughout the facility to cause a hazard. Therefore, based on observations and interviews this allegation is deemed Unsubstantiated. No citations issued. Exit interview conducted. Copy of report given to Administrator.the state’s words, verbatim · CDSS document, Sep 24, 2024 · control 31-AS-20230612155207

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Mariana Agban and Perchui Khurshudyan conducted an Annual Required visit and inspection of the facility. LPAs met with staff and explained the reason of the visit. At approximately 10:45 am, with the assistance of staff, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms were tested and function properly. The carbon monoxide detector was tested and functions properly.The fire extinguisher is located in the hallway. The purchase date Jan 3,2023. Kitchen: The kitchen appliances and fixtures were functional. LPAs 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: There were four (4) bedrooms designated for residents' use. Three (3) designated for residents' use and one (1) for staff. All three bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are one (1) bathroom designated for residents' use. The bathroom was properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 105.3 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located in the garage, which is inaccessible to residents. Resident Files: LPAs conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPAs also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were reviewed. LPAs observed LEVOTHYROXINE medication is short by 1 bill for 2 out 2 residents. Assistant administrator couldn't explain the reason for the shortage. They were advised to use Medication Administration Record (MAR) to prevent any future issues with medications. Exit Interview conducted, citation issued and a Copy of the Report deliveredthe state’s words, verbatim · CDSS document, Feb 23, 2024