Anna's Home for the Elderly

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct the required annual visit. Upon arrival, the LPA was greeted by staff who then contacted the Administrator telephonically. Administrator, Marilou Mallari arrived at approx. 08:40 a.m., and the reason for the visit was explained. Entrance interview. Beginning at 08:45 a.m., LPA and 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. There are five (5) bedrooms in the facility for resident use; four (4) bedrooms are designated as private, single occupancy rooms, and (1) bedroom is designated as a double, shared occupancy room. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. There is a closet with additional clean linens and towels for resident use. There are three (3) restrooms in the facility for resident use. Restrooms were observed to be clean and in sanitary condition. Grab bars and slip resistant floor were observed. Restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured starting at 08:58 a.m., and they measured within the required range of 105 – 120 degrees Fahrenheit during the inspection. The LPA observed the garage which was inaccessible to residents at the time of the visit. There is a washer and dryer inside the garage. Toxins and detergents were observed locked and inaccessible during the inspection. A sufficient supply of emergency food and water was observed. Report Continued on LIC 809C... Report Continued from LIC 809... The backyard has a covered patio area with shade, patio furniture including tables and chairs for resident use. All passageways were observed to be clear of any obstruction. LPA observed two (2) self-latching gates. No bodies of water noted at the time of the visit. The LPA observed the common areas. This includes the living room 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. The fire extinguisher was observed to be fully charged with a charge date of 05/14/2025. LPA observed required postings throughout the common space. Activities were observed in the common areas. There is a functioning telephone on the premises. The kitchen/food service area was observed at approx. 09:05 a.m. Knives and sharps were observed in a cabinet. Cleaning supplies and other chemicals are kept locked under the sink area. 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. At 09:08 a.m., the hot water temperature was measured in the kitchen sink, and it measured 120 degrees Fahrenheit. Record review began at approx. 09:40 a.m. Four (4) 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, PRN authorization letters, and current needs and services plan. Files were complete. Three (3) 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 files were in order. During today’s visit, LPA reviewed the facility’s emergency disaster plan. Emergency disaster drill are being conducted quarterly as per regulation; last one conducted on 12/01/2025. LPA conducted a medications review. Medications are centrally stored in a cabinet by the kitchen. Medications are properly documented on the centrally stored medications and destruction records. Medications appear to be administered as prescribed at the time of the visit. Exit interview conducted. A copy of report was provided.the state’s words, verbatim · CDSS document, Dec 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at 9:30am. Upon arrival, there were two (2) staff and four (4) residents present. The LPA was greeted by facility staff who contacted the Administrator via telephone. The Administrator, Annabelle Ramos arrived during the inspection. Entrance interview conducted. Starting at 10:40am, the LPA along with staff 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: KITCHEN: The LPA inspected the kitchen/food service area. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Knives and sharps were observed locked and inaccessible in a kitchen cabinet. At 10:48am, the hot water temperature was measured in the kitchen sink, and it measured at 108.5 degrees Fahrenheit. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be fully charged with a date of 05/08/2024. Required postings were observed throughout the common space. Activities were observed accessible to residents in care. There is a working telephone on premises. The LPA observed a closet in the hallway with additional clean linens and towels. Working auditory alarms were observed at the time of the visit. Report Continued on LIC 809C... Report Continued from LIC 809... RESTROOMS: There are three (3) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 9:42am, the hot water temperature was measured in all bathrooms, and they measured between 107.5 and 110.8 degrees Fahrenheit. BEDROOMS: There are four (4) bedrooms for resident use. Two (2) bedrooms are designated as single occupancy, and two (2) bedrooms are designated for double occupancy. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPA observed a staff bedroom on premises. GARAGE: The garage was locked and inaccessible to residents at the time of the visit. The LPA observed an adequate amount of emergency food and water. Washer and dryer were observed inside the garage. Additional cleaning supplies are kept in the garage locked and inaccessible to residents in care. BACKYARD: The backyard has a covered patio area with patio furniture for resident use. All passageways were observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms. No bodies of water noted at the time of the visit. RECORDS: The LPA reviewed Resident Records at 10:20am and Personnel Records at 11:05am. Four (4) 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 files were in order. Report Continued on LIC 809C... Report Continued from LIC 809C... Five (5) personnel files including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All records were in order. Administrator’s Certificate is valid until 12/01/2025. The LPA conducted interviews with two (2) staff during the inspection. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: 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. Emergency disaster drills conducted quarterly as per regulation; last one conducted on 12/17/2024. MEDICATIONS: Medications review began at approximately 12:20pm. Medications are kept in a locked cabinet in the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are properly documented on the centrally stored medications and destruction record. Medications appeared to be given as prescribed at the time of the visit. No citations issued. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 23, 2024

Allegation investigated: Staff confined residents to their rooms. Staff did not provide a safe and comfortable environment for residents.

Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent visit to the facility to issue findings for the above allegations. The initial visit was conducted on 02/29/2024 by LPA M. Arroyo. During today's visit, LPA met with staff, Elisa Talbo. The staff called the Administrator, Annabelle Ramos at 6:25 p.m. and LPA shared findings telephonically. Entrance interview. During the initial visit on 02/29/2024, the LPA conducted a tour of the facility to ensure there were no immediate health and safety concerns at 9:10 a.m., conducted interviews with the Administrator, one staff member, and three residents between 9:30 a.m. and 10:45 a.m., and obtained copies of pertinent documents relevant to the investigation. On 03/01/2024, LPA Arroyo conducted a telephonic interview with Simi Valley Officer (SVO) at 9:46 a.m. Police Report was also obtained and reviewed. Continued on LIC 9099C... Unsubstantiated Continued from LIC 9099C... It was alleged that staff confined residents to their rooms and staff did not provide a safe and comfortable environment for residents. It was reported that facility staff is using rope and a screwdriver as a method to prevent residents from exiting their bedrooms and is a method of restraining residents within their bedrooms. During the facility walkthrough on 02/29/2024, the LPA observed two (2) residents in their beds, one (1) resident sitting in their room browsing through a magazine, and one (1) resident watching television in the living room. LPA observed all door and doorknobs in the facility, and rope was nowhere in sight at the time of the visit. Additionally, holes on the walls were observed to be filled in and closed upon LPA inspection. Interview conducted with law enforcement revealed that two (2) officers had received a call to conduct a welfare check at the facility. Officer stated that upon arrival, facility staff opened the front door and allowed them to go inside without hesitation. Residents were observed inside their rooms on their beds and others doing activities. Additionally, officers went to every single room and did not observe any screwdrivers in sight or rope hanging anywhere or visible. Furthermore, per Police Report it states inspection demonstrated a commitment to maintaining a safe and nurturing environment for its residence and no violations of concerns were identified during the search. Interviews conducted with staff revealed that the holes have been present at the facility prior to them working at the facility. Additionally, staff added that all room doors have door locks for residents to use if they want privacy at any time. Interviews conducted with residents revealed that staff encourage the residents to go outside; however, they choose to stay inside. Additionally, residents stated that family members often come to the facility and visit. Furthermore, residents stated they are comfortable living at the facility and reported feeling safe. Although the allegations may have happened or are valid, there is insufficient evidence to prove the alleged violations occurred, therefore these allegations are deemed Unsubstantiated at this time. No citations issued at this time. Exit interview conducted. Report was reviewed and a copy was issued.the state’s words, verbatim · CDSS document, Mar 21, 2024 · control 29-AS-20240223090557

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today at 9:00 a.m. The last annual conducted at this facility was on 12/16/2022. When the LPA arrived, there were two (2) staff and four (4) residents present. The LPA was greeted at the door by staff Wilfredo Ladio. The Administrator arrived at the facility at 9:35 a.m. and the reason for the visit was explained. Entrance interview conducted. At 9:40 a.m., the LPA along with 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. KITCHEN: The LPA inspected the kitchen/food service area at 9:51 a.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked. The knives and sharps are stored in a locked drawer inaccessible to residents in care. At 9:52 a.m., the water temperature was tested in the kitchen faucet, and it measured 112.1 degrees Fahrenheit. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed one resident watching television in the dining room during the inspection. The facility maintained a comfortable temperature. At 10:01 a.m., the smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 09/11/2023. Different activities are offered to residents daily. The LPA observed reading books and puzzles accessible to residents in care. The LPA observed a closet in the hallway with extra towels and linens. (Report Continued on LIC 809C...) (Report Continued from LIC 809...) A separate closet was observed with at least a 30-day supply of Personal Protection Equipment (PPE). The LPA observed required postings throughout the common space. GARAGE/BACKYARD: The garage is kept locked at all times. The washer and dryer were observed in the garage. Detergents and cleaning solutions were observed in a locked cabinet. The facility has emergency food and water which was observed to be in good condition. The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There were two (2) gates with self-latching mechanisms. No bodies of water were noted at the time of the visit. BEDROOMS: There are four (4) resident bedrooms. Bedrooms #1 and #4 are shared bedrooms. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There is a staff room on premises. RESTROOMS: There are three (3) resident restrooms. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured in all bathrooms; the first bathroom measured 114.6 degrees Fahrenheit at 9:43 a.m.; and the second bathroom measured 114.8 degrees Fahrenheit at 9:47 a.m.; and the third bathroom measured 113.7 degrees Fahrenheit at 9:49 a.m. RECORDS: Records review began at 10:06 a.m.; four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At 10:15 a.m., record review of Resident #1’s (R1’s) Physician’s Report (LIC 602A) indicates R1 has no capacity for self-care; however, can feed themselves occasionally. Records indicate R1 was discharged from hospice and Licensee stated they will have R1 re-evaluated to indicate R1 has capacity for self-care. (Report Continued on LIC 809C...) (Report Continued from LIC 809C...) Four (4) personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were complete. The LPA also audited the current Administrator’s file, and it was in order. The last earthquake drill took place on 10/23/2023. At the time of the visit, the LPA obtained the following documents: LIC 500 Personnel Report, LIC9020 Client Roster, and a copy of the liability insurance. MEDICATIONS: Medications review began at approximately 12:15 p.m.; medications are centrally stored and locked in a cabinet inside the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during medications review. Exit interview conducted. No deficiencies cited. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 27, 2023

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.