Arcadia Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility at 3:45, to conduct an annual inspection. LPA met with administrator John Villareal, and explained the purpose of the visit. A physical inspection was conducted to include the bedrooms, bathrooms, kitchen, common areas, exteriors, and evacuation route gates. The facility is clean, and the traffic areas are unobstructed and well lit. The bedrooms, have all required furniture, not including mattress encasements. LPA gave guidance that in the event of a bed bug infestation of the bedclothes, its possible for the eggs of the bugs to shake out onto the bare mattress and cause the infestation to recur. The bathrooms, have functional hardware. Water is measured as between 105 and 120*F. Toliet seat is unsecured, the LPA was shown a work order dated 6/23/26. Kitchen has lockable storage for sharps, toxics, and medications. There is enough food for 2 days perishable and 7 days non perishable. 2 resident's mars were checked against available medication, found to be in agreement. Refusal documentation is light, LPA gave guidance to model the documentation for prn's and refusals on the layout thats on the back of the MAR sheets. continued on C page. Common areas and exteriors had adequate space for activities and free of trip hazards and insects. The evacuation route gate swings freely and latches closed. The emergency gate is the front of the facility, its always open. Fire extinguishers are dated September of 25 and first aid kit has all necessary components. 5 resident files were reviewed and found to contain health screenings, needs and services plans, medical evaluation, and signed admission agreement. Files are up to date and present. 3 staff files were reviewed and found to contain health screenings, first aid, recent and initial trainings, and qualification paperwork. Files are up to date and present. Administrator files were reviewed: infection control plan, evacuation plan, required posters(ombudsman, resident rights, federal workers rights, facility sketch, administrator certificate). Workers comp, Liability insurance, and secretary of state filings are up to date and present. LPA asked for an updated copy of the 610d to be emailed to (noel.wolfpetersen@dss.ca.gov) 1 resident interviewed, 1 staff interviewed. No citations issued, a copy of the report was read and given to the administrator. exit interviewthe state’s words, verbatim · CDSS document, Jun 23, 2026

Allegation investigated: Staff does not safeguard resident’s personal belonging(s).

Licensing Program Analyst, LPA Noel Wolf Petersen, arrived unannounced to the facility to conduct a complaint investigation into the above allegations, which resulted also in delivering findings. LPA met with the administrator john villareal by phone to explain the purpose of the visit. In interviews with a resident R1 it was claimed that 4 items were not being safegaurded, and all four were given away with the permision initially by R1, who then had trouble repossessing thier items. Only one of the incidents occured between residents inside of the facility, in other cases the items were given to nonstaff individuals outside of the facility. R1 was in possession of the safegaurded item at the time of the interview. R2 who was claimed to have temporary unwanted possession of the safegaurded item, is no longer residing in the facility. 3 facility staff made the statement, they dont recall the incident specificly but the normal facility procedures for enforcing the house rules about a item taken without permission would have happened soon after the incident was reported. further,that trading or lending personal items between residents is discourged and not taking each others property without permission is explained as part of the house rules at admission. LPA gave guidance a incident where house rulse are enforced would be a good thing document internally by the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. no citations issued as part of this visit. A copy of the report was read to the adminstrator over the phone and a copy given to the staff designated for signature. exit interview was conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 29, 2026 · control 27-AS-20260211090659

Type of visit: Required - 1 Year

On 05/22/25, LPA Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Administrator John Villareal and explained the purpose of the visit. LPA Campbell inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. This facility is a single story building licensed to serve fifteen (15) non-ambulatory residents, of which eight (8) may be bedridden. There is a hospice waiver for fifteen (15). LPA Campbell observed bedrooms to be properly furnished with appropriate bedding and lighting. LPA Campbell observed fire extinguisher and water sprinklers in good repair. The facility uses a manual fire alarm pull system, smoke alarm and sprinkler system to initiate notification of emergency services. The facility thermostat was observed at 75 degrees Fahrenheit. LPA Campbell checked medication storage and found medication to be locked away and inaccessible to clients. The first aid kit contained bandages, scissors, tweezers and a thermometer. No manual was present in the first aid kit. The administrator will provide proof of a manual to the LPA by Wednesday the 28th of May. LPA Campbell requested staff files for review. LPA reviewed 4 of 4 staff files and they were found to be complete and all staff were fingerprint cleared. Toxins were made inaccessible to clients in care and locked in the staff bathroom. The medication administration record (MAR) was reviewed and found to be complete with a detailed accounting of medications that have been provided to residents. During the course of this visit, staff unclogged a shower drain and tightened the fittings for a bathroom faucet. Per California Code of Regulations, Title 22, no deficiencies were observed during today’s visit. A copy of this report was provided to the facilitythe state’s words, verbatim · CDSS document, May 22, 2025

Type of visit: Case Management - Incident

On 04/03/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to conduct a Case Management regarding an Unusual Incident Report (UIR) for a 03/21/25 incident. LPA Campbell met with Administration John Villareal and explained the purpose of the visit. The resident had gone to the hospital on 03/18/2025 due to low blood pressure and an inability to stand. After the resident was discharged from the hospital on 03/20/25, he was no longer able to stand on his own and continuously fell from his bed and lost control of his bodily functions. Per the administrator, the facility could not meet his needs. The administrator contacted R1's Case Worker, Sonia Martin from Turning Point. The Case Worker called 911 and asked A to retrieve R1 from the facility and return them to the hospital because R1 was extremely weak and could not stand. The case worker was contacted by LPA Campbell but could not speak without an ROI. Once received, there could be further discussion At this time, no deficiency is being cited. This incident is currently under review and a future citations or penalties may apply. Exit interview conducted and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 3, 2025

Type of visit: Post Licensing

On 04/03/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced for a post-licensing visit. LPA Campbell met with Sharon Basaldua, Caregiver, and explained the purpose of the visit. Upon entry to the facility grounds, LPA Campbell observed two clients sitting on the porch. Staff were passing out medications for residents and preparing breakfast. Administrator John Villareal (Certificate #6069582740) arrived to the facility at approximately 9:00 AM. The facility ownership change was completed on 06/18/2024. A hospice waiver for 15 clients was granted at the same time. The facility is licensed to serve clients age 60 and over,15 of which may be non-ambulatory and 8 may be bedridden. The new licensee is Arcadia Care Home, LLC. Per the administrator, there are four people on staff and 15 clients residing in the facility. LPA Campbell toured the physical plant to ensure there were no health or safety concerns. The dining room, bedrooms, kitchen, and bathrooms were observed. Staff had recently mopped the floors and bedrooms were found to be in good repair. The thermostat was set at 69 degrees Fahrenheit (F) and the fire extinguisher was observed to be fully charged and last inspected on 09/24/2024. All staff were verified as having been finger-print cleared. Of the four client files reviewed, all were found to be complete. Licensee was provided technical advisory regarding first-aid certification and LPA Campbell consulted with staff on organization of client files. No deficiencies are cited during today's inspection. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Apr 3, 2025

Type of visit: Prelicensing

On 06/12/24, Licensing Program Analyst (LPA) Renee Campbell arrived announced to conduct a Pre-Licensing Visit. LPA Campbell met with John Villareal and explained the purpose of the visit. This Pre-Licensing Visit is due to a change of ownership. The facility has a fire clearance for 7 non-ambulatory and 8 bedridden residents. A tour of the facility kitchen and food storage was conducted. Knives were observed to be locked and made inaccessible to the residents in care. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supplies to meet the resident’s needs. There is 1 smaller refrigerator for short term storage in the kitchen. In the staff office, there are 2 larger refrigerators and 1 large freezer for long term perishable storage. The facility holds enough extra non-perishable food supplies to last seven days in the same office. A monthly menu was attached to the refrigerator in the kitchen. LPA observed a locked centralized stored medication cabinet located in the dining room. Along with the administrator, the LPA observed and reviewed the client Medication Administration Record (MAR) put in place in May of 2024. Staff are able to track if clients have accepted or refused medication and log PRN usage. The First Aid Kit was present and contained all the required components including a thermometer, scissors and tweezers. A fire extinguisher was in the kitchen and hallways. They were serviced on 9/14/2023. Facility water temperature was measured at 105 degrees Fahrenheit and the thermostat was set at 80 degrees Fahrenheit. Dining areas, living areas, and all other areas intended for resident use were toured. The dining room contained a leather couch set. Books and games were observed on shelves. Resident bedrooms contained a bed, lamp, chairs, night stands and closets. Residents were observed walking and socializing in the hallways and dining room. Dinner occurred at 4:30 pm and residents were observed receiving their medication at 3:30 pm. The laundry room off the kitchen contained a washer and dryer and detergents that were inaccessible to residents. tour of the laundry room was conducted, laundry detergent, bleach and all other cleaning supplies were made inaccessible to the residents in locked cabinets in the staff bathroom. Pre-Licensing is complete, and this facility has no deficiencies. A Component III was completed at this time with the Applicant. Administrator Villareal had no further questions. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report was given to the applicant.the state’s words, verbatim · CDSS document, Jun 12, 2024