Arveah's Care Homes 3

Type of visit: Required - 1 Year

At approximately 9:10 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Care Giver (CG) Grecita Tenio. Administrator Juan Santos arrived at 9:30 AM. Arveah's Care Home 3 is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were five (5) residents in care and three (3) staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:35 AM, LPA toured the facility with Administrator Santos. All exits were clear and unobstructed. The facility's one (1) fire extinguishers were last serviced and tagged on 1/3/2025. Fire Department inspected and cleared the facility on 7/8/2025. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills monthly. The last disaster drill was conducted on 7/7/2025. Continued on 809-C... ...Continued from 809 The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and found to be operational. At approximately 10:25 AM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed with all required documentation. LPA reviewed three (3) staff files. All staff files were observed with all required documentation including First Aid and CPR certification and training documentation. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. The facility's corporate entity, Arveah's Care Homes, LLC standing status is showing as "Suspended/FTB" on the California Secretary of State website. As such the facility will be cited for this deficiency. As an application has been submitted for this facility to have a new licensee, this deficiency will be cleared during today's visit. Juan Santos’s Administrator Certification 7031805740 is current with an expiration date of 10/22/2025. LPA requested the following documents be submitted to Community Care Licensing by 8/25/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator Santos. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 25, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff did not report an incident to the licensing agency.

On 12/06/2024, at approximately 11:55 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver findings for the above allegation and met with John Piolo Danting, Designated Responsible Party. Reporting Party (RP) alleges that Licensees failed to report to Community Care Licensing (CCL) a reported potential incident of physical assault by former Staff 1 (S1) on Resident 1 (R1). LPA conducted 10-day on 09/06/2024 and conducted interviews, made observations, and obtained documents. LPA interviewed 5 of 6 residents, Licensees, Staff 2 (S2), Staff 3 (S3), and Staff 4 (S4). Said interviews confirmed that Licensees were informed of the potential physical assault and Licensees failed to report the allegation to CCL. Licensees were unable to provide proof that an incident report was submitted to CCL and LPA confirmed that CCL did not receive an report for the alleged incident. Continued on LIC9099C... Substantiated Continued from LIC9099... Based on interviews conducted, observations made, and record review, the allegation listed above is SUBSTANTIATED. A finding that a complaint allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency is cited from Title 22 Regulations, Division 6, (see LIC9099D). Exit interview conducted. Copy of report discussed and provided to Licensee, whose signature on form confirms receipt of documents. Appeal rights provided.the state’s words, verbatim · CDSS document, Dec 6, 2024 · control 21-AS-20240904015421

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(c) · Plan of correction due date: Dec 9, 2024

87211(c) Reporting Requirements: Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement... agency within twenty-four (24) hours.... This requirement was not met as evidenced by: Licensee failed to report a known potential incident of abuse to CCL which posed a health, safety, and personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2024

Plan of correction: Licensee to submit self-certification that they will ensure all known actual and potential incidents are reported to CCL within the required timeframes and that the regulation has been reviewed with care staff. LIcensee agrees to submit this to CCL by POC due date 12/9/2024.

Allegation investigated: Staff physically assaulted a resident in care. Staff are not meeting the medical needs of a resident in care. Staff made an inappropriate comment towards a resident in care.

On 12/06/2024, at approximately 11:15 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver findings for the above allegations and met with John Piolo Danting, Designated Responsible Party. Reporting Party (RP) alleges that Resident 1 (R1) was physically assaulted by former Staff 1 (S1), that staff talk down to R1, and that the facility is not taking R1 to the doctors to be treated or for medications. LPA conducted 10-day on 09/06/2024 and conducted interviews, made observations, and obtained documents. LPA was able to interview 5 of 6 residents, Licensees, Staff 2 (S2), and Staff 3 (S3). The interviews provided conflicting information regarding all 3 allegations. LPA did not observe any signs of injury or neglect of residents’ care needs during inspection. LPA was informed that the Vacaville Police Department was notified of suspected abuse by a staff member. Continued on LIC9099C... Unsubstantiated Continued from LIC9099... Reports were obtained which include a name not known to the facility and state an unfounded determination. Based on interviews conducted, observations made, and record review, the allegations listed above are UNSUBSTANTIATED. A finding that complaint allegations are unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED. No Deficiencies cited during visit. Exit interview conducted. Copy of report discussed and provided to Designated Responsible Party, whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Dec 6, 2024 · control 21-AS-20240904015421

Allegation investigated: Staff sexually abused resident in care. Uncleared staff caring and supervising resident in care.

On 12/6/2024, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver findings for a complaint the Department investigated related to the allegations of “staff sexually abused resident in care” and “uncleared staff caring and supervising resident in care”. Based on a review or records and interviews with staff, resident, and outside parties the allegations are UNSUBSTANTIATED. During the investigation the Department learned resident listed as R1 refused peri-care from a caregiver and indicated there was injury to their groin area. Caregiver did not observe injury and contacted the licensee who arrived timely to assess. R1 allowed licensee to provide peri-care and observe for injury, no injury was observed. Reporting Party indicated staff listed as S4 and S5 suspected staff listed as S3 to have possibly abused R1. There was no evidence to corroborate this allegation. Vacaville PD report was obtained and reviewed. Continued on LIC9099C... Unsubstantiated Staff listed as S3, S4 and S5 were fingerprint cleared and associated to work at facility. Personnel records were observed to be current and on file for these individuals during a Case Management visit conducted on July 9, 2024. These individuals are no longer employed at facility, S3 left in July of 2024 and S4 and S5 left in August of 2024. Complaint findings delivered today, no citations issued. Exit interview conducted with Designated Responsible Party, whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Dec 6, 2024 · control 21-AS-20240918103321

Type of visit: Case Management - Annual Continuation

At approximately 09:45 AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required continuation inspection of this licensed senior care facility. LPA was greeted by Administrator, Leah Davis-Martinez. The facility is a single story home licensed for six (6) non-ambulatory residents and a hospice waiver capacity of four (4). The facility currently provides care for 6 residents, one resident is on hospice and bedridden. In addition, all residents have a diagnosis of dementia. At approximately 10:00AM, LPA reviewed 6 of 6 Client records and 4 of 4 Staff records, which were all found to be well organized, thorough and contained the required documentation. First aid and CPR certification were current in staff files reviewed. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Resident Roster Evidence of Liability Insurancethe state’s words, verbatim · CDSS document, Jul 9, 2024

Type of visit: Required - 1 Year

At approximately 8:45 AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA was greeted by caregiver, Gener Reyes L. Administrator, Arvan Davis-Martinez, arrived shortly after at approximately 10:45 AM. The facility is a single story home licensed for six (6) non-ambulatory residents and a hospice waiver capacity of four (4). The facility currently provides care for 6 residents. In addition, all residents have a diagnosis of dementia. At approximately 9:00 AM, LPA and Caregiver toured the building and grounds which was not found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Signed on 07/09/2024 Continued on 809C Continued from 809 LPA observed food items in freezer that were not properly stored showed signs of freezer burn. LPA observed refrigerated medication not secured/lock in unclosed bin on the top shelf of the refrigerator. LPA advised Administrator to get a lock box to store medication in the refrigerator. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulation. Toxins are stored in a locked cabinet in the kitchen, and in the garage. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen drawer. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water temperature measured within regulation between 116 and 117 degrees F at two of four faucets accessible to residents. Two of two fire extinguisher were onsite. Ten out of ten Smoke/Carbon monoxide detectors were present will are present. There was enough lighting in all common areas, resident rooms, and hallways. LPA to continue Annual as facility is in the process of going digital and due to resident diagnosed with dementia demanded LPA leave the house and LPA to continue annual next week when residents are in their room to prevent further aggitation.the state’s words, verbatim · CDSS document, Jun 13, 2024

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.