Anita's Care Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. The LPA met with Administrator Jennifer Shaffer and explained the reason for the visit. RECORD REVIEW: Starting at 12:50 p.m., the LPA conducted a file review for all four (4) residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to: care plans, medical records, admissions agreement, consent forms. All files were in order. Administrator’s Certificate expires on 05/25/2027. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually as required. The last fire/earthquake drill was conducted on 04/02/2026. Beginning at 02:08 p.m., the LPA along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The following was observed: BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) for staff use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and slip resistant surfaces. Hot water measured within required range. Report Continued on LIC-809-C OUTDOOR SPACE: The LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. The garage is attached and remains inaccessible to residents. Laundry units are located inside the garage. Cleaning solutions are located inside the garage. There are no bodies of water on the premises. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last serviced on 04/23/2026. At 03:15 p.m., fire alarms/carbon monoxide detectors and fire door were tested and functioned properly. There is a working telephone on premises. The LPA observed additional clean linens and towels in the hallway closets. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored locked and inaccessible inside a kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food and emergency water. MEDICATION REVIEW: At 02:32 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for two (2) residents. Medications are centrally stored and inaccessible inside a locked cabinet near the kitchen area. First aid kits are located throughout the facility. No medication discrepancies were observed. During the time of the visit, the LPA conducted interviews with two (2) residents and one (1) staff. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 3, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Office

On 05/14/2026, an Informal Conference was held at the Woodland Hills Adult and Senior Care Regional Office. In attendance included Licensing Program Manager (LPM) Desaree Perera, Licensing Program Analyst (LPA) Martha Arroyo, and Licensee Representative (LR) Jennifer Shaffer. The purpose of today’s Informal Conference is to discuss a complaint dated 01/04/2022 (Complaint Control # 29-AS-20220104110534) and complaint dated 05/23/2022 (Complaint Control # 29-AS-20220523095227). The Administrative Action process was explained to the Administrator, as well as the role of an Informal Conference. On 01/04/2022, the Department received a complaint alleging that resident developed pressure injuries while in care. The complaint was substantiated on 06/24/2022 and citation was issued for Basic Services. Additionally, the Department conducted a Case Management and issued citation for violations observed during the course of the investigation which included Prohibited Health Conditions. On 05/23/2022, the Department received a complaint alleging that facility failed to provide resident’s records to resident’s authorized representative. The complaint was substantiated on 05/31/2022 and citation was issued for Additional Personal Rights of Residents in Privately Operated Facilities. Discussions were held regarding the admission of residents with Prohibited Health Conditions, as well as the proper protocols and Title 22 regulations related to admitting residents with Stage 3 and Stage 4 pressure injuries. Report Continued on LIC 809C... Report Continued from LIC 809... The LR acknowledged that the resident should not have been admitted and stated that no additional residents with similar conditions have been admitted since the incident, as it served as a learning experience in properly assessing residents prior to admission to the facility. The LR stated that the resident refused assistance related to the pressure injury after being admitted to the facility, which caused the injury to worsen, although staff attempted to provide assistance at all times. LPM informed the LR that they are able to seek advice from their LPA. Additionally, the LPM discussed the importance of properly documenting all resident care activities, including repositioning residents who require such assistance, and ensuring that all documentation is complete and accurate, including updating appraisals and service plans whenever there is a change in a resident’s condition. The LR stated that they are being more cautious and are conducting thorough assessments of residents by meeting with both the resident and their family to ensure that the facility can meet the resident’s needs prior to admission. Additionally, the LR stated that they have become more organized and are utilizing all available resources. During today’s meeting, the LR submitted a Statement of Understanding acknowledging that they have learned from this experience to ensure it does not happen again. Exit interview conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, May 14, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 1:45 p.m., the LPA met with Administrator Jennifer Shaffer and explained the reason for it visit. RECORD REVIEW: Starting at 1:53 p.m., the LPA conducted a file review for one (1) resident and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. Administrator’s Certificate is pending. At 2:20 p.m., the LPA along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored locked and inaccessible inside a kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 2:28 p.m., hot water measured at 105.3-degree Fahrenheit. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) for staff use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Hot water measured within required range. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC-809-C. OUTDOOR SPACE: At 2:22 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. The garage is attached and remains inaccessible to residents. Laundry units are located inside the garage. Cleaning solutions are located inside the garage. There are no bodies of water on the premises. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last serviced on 05/15/2025. At 2:38 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. There is a working telephone on premises. The LPA observed additional clean linens and towels in the hallway closets. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated. The last fire/ earthquake drill was conducted on 06/09/2025. At 2:42 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for one (1) resident. Medications are centrally stored and inaccessible inside a locked cabinet near the kitchen area. First aid kits are located throughout the facility. During the time of the visit, the LPA conducted an interview with one (1) resident. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jun 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kelly Dulek and Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 11:01AM. LPAs met with Licensee/Administrator Jennifer Shaffer. Entrance interview conducted. Beginning at 11:15AM, the LPAs, along with Licensee/Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers are fully charged and recently serviced on 04/03/2024. Hardwired combination smoke and carbon monoxide detectors and fire door were tested at 12:45PM and all were functional at the time of the visit. No fire clearance concerns were observed. BEDROOMS: There are 5 (five) total bedrooms in the facility; 2 (two) are designated as shared rooms, 2 (two) are designated as private resident rooms and 1 (one) is utilized as a staff room. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Room #1, which belongs to Resident #1 (R1) was observed to have full bed rails. Room #4, belonging to Resident #2 (R2) contained unsecured Advil in the resident's drawer. Staff room was observed to be locked. BATHROOMS: There are 2 (two) bathrooms for resident use. 1 (one) is designated for shared resident use and the other 1 (one) is a private resident restroom. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in both resident bathrooms and measured within the required range. COMMON AREAS: This includes the living room and dining room areas. LPAs observed common area to be clean and properly furnished at the time of the visit. A fireplace was observed in the living room and was inaccessible to residents in care. Exit doors contain alarms and were functional at the time of the visit. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs Report Continued on LIC 809-C for resident use. All passageways were observed to be clear. There were no bodies of water on the premises. An outdoor shed was observed to be locked and inaccessible to residents. KITCHEN/GARAGE: The LPAs observed the garage to be locked and contain cleaning supplies, knives, emergency food, additional refrigerator/food storage, as well as supplies and laundry machines. Kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Cleaning supplies are located in a locked under-sink cabinet. Medications were observed to be in a locked kitchen cabinet. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPAs reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill conducted on 04/03/2024. RECORD REVIEW: Staff and resident 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. Review of R1's file revealed that R1 is not on hospice and R1 does not have a valid exception on file. Review of R2's file revealed that R2 cannot store their own medications. 5 (five) staff files observed contained all documents. MEDICATION REVIEW: Medications for 2 (two) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. INTERVIEWS: During today's visit, LPAs interviewed 2 (two) staff and 2 (two) residents. During today's visit, LPAs obtained a copy of the facility's liability insurance. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 17, 2024

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.