Assure Care Villa

Allegation investigated: Resident sustianed serious injuries as a result of elopment due to lack of supervision Staff did not notice change in resident's condition Staff did not seek higher level of care

Licensing Program Analyst (LPA) Mariana Agban conducted a complaint investigation visit regarding the above allegation. LPA met with Dennis Bonifacio and explained the reason for the visit. Based on interviews conducted with staff and Resident Roster review it was determined that Resident#1 (R1) has never resided in this location. Therefore, the allegation is unfounded. This agency has investigated the complaint alleging "Resident sustianed serious injuries as a result of elopment due to lack of supervision, Staff did not notice change in resident's condition and Staff did not seek higher level of care ”. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened, and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted and copy of this report issued. Unfoundedthe state’s words, verbatim · CDSS document, Aug 27, 2026 · control 31-AS-20260617092755

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 Designee Dennis Bonifacio, and explained the reason for the visit. At approximately 10:00 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. 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. The laundry area is located through the kitchen. The washer and dryer were observed to be in good condition. No toxins or other hazards items were present. Bedrooms: There were five (5) bedrooms designated for residents' use. Four (4) bedrooms are designated for private use, and one (1) room is shared. All five bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Currently, Room 4 is vacant. Bathrooms: There were four (4) bathrooms in the facility. One (1) bathroom in hallway and three (3) bathrooms in the private bedrooms. All bathrooms were clean, properly supplied and had functional fixtures. Hot water temperature was 109.7 degrees Fahrenheit. Cleaning supplies were kept in locked cabinets. Temperature: Facility maintains a comfortable temperature of 77 degrees Fahrenheit. Resident and Staff files: LPA conducted file review of one resident out of 5 and two staff members. LPA was unable to complete the annual inspection during today's visit. The administrator was informed that a follow-up visit will be conducted.the state’s words, verbatim · CDSS document, Aug 27, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced continuation of the annual inspection. LPA met with Dennis Bonifacio and Susan Nuguid and disclosed the reason for the visit. LPA reviewed 2 residents' files and observed that R5 does not have an updated Appraisal Needs and Services (LIC 625) as well as a hospice care plan. LPA also reviewed the medication and the medication record for proper documentation. LPA observed that the R4 Medication record is incomplete. LPA also observed that the facility does not have an activity calendar in place. LPA also noted that there were no fire drills conducted. Exit interview conducted. citations issued, Copy of report provided.the state’s words, verbatim · CDSS document, Aug 28, 2025

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 staff Dennis Bonifacio, and explained the reason for the visit. LPA was informed that Florence Peregrino is no longer administrator of the facility as there was a change within the organization since January of 2025. LPA was given the contact information of Susan Nuguid, the new Administrator and was informed that Mrs. Nuguid is out of the country. Administrator Nuguid had assigned staff Dennis to Bonifaco to sign the report. At approximately 11:15 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. 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. The laundry area is located through the kitchen. The washer and dryer were observed to be in good condition. No toxins or other hazards items were present. Bedrooms: There were five (5) bedrooms designated for residents' use. Four (4) bedrooms are designated for private use, and one (1) room is shared. All five bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Currently, Room 4 is vacant. LPA was informed that R1 had passed away on or around June 13, 25. LPA conducted a file review and did not observe any death report had been sent out to CCL regarding R1's death. Bathrooms: There were four (4) bathrooms in the facility. One (1) bathroom in hallway and three (3) bathrooms in the private bedrooms. All bathrooms were clean, properly supplied and had functional fixtures. Hot water temperature was 110.6 degrees Fahrenheit. Cleaning supplies were kept in locked cabinets. Temperature: Facility maintains a comfortable temperature of 77 degrees Fahrenheit. (Continue on 809C) Smoke Alarms and Carbon Monoxide: detectors were tested and function properly. Fire extinguisher is located in the kitchen with purchase date 11/4/24. Common Areas: These included the living room and dining area. The common areas were properly furnished with adequate couches, chair, and television. The dining area had a large table, to seat up to six (6) individuals. Furniture in common areas were clean and in good repair. Floors were mopped and clean. Hallways and passageways were clear of any obstruction. Surrounding Grounds: Entry/exits were free of obstruction. LPA observed the outdoor area to be cluttered with unused bedframes, broken exercise machines and outdoor furniture. No lock on the side gate. Resident Files: LPA conducted a file review of two out of 5 residents records to ensure compliance of licensing forms. LPA observed that R2 and R3 Appraisal Needs and Services (LIC 625) are not updated. Staff Files: LPA was unable to conduct staff file review for S1 as there was no physical file for S1. LPA conducted file review for 2 out 2 present staff. LPA requested copy of the liability insurance. LPA was informed that there are no physical copy of the liability insurance on file. LPA was unable to complete the annual inspection during today's visit. The administrator was informed that a follow-up visit will be conducted. Exit interview conducted. Citations issued, appeal rights given, Copy of report provided.the state’s words, verbatim · CDSS document, Aug 14, 2025

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 staff 1 (S1) and explained the reason for the visit. Administrator, Florence Peregrino had arrived shortly after. At approximately 10:15 am, with the assistance of staff 1 (S1), LPA took a tour of the physical plant. Required postings were observed in the entry area. 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. The laundry area is located through the kitchen. The washer and dryer were observed to be in good condition. Bedrooms: There were five (5) bedrooms designated for residents' use. Four (4) bedrooms are designated for private use, and one (1) room is shared. All five bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There were four (4) bathrooms in the facility. One (1) bathroom in hallway and three (3) bathrooms in the private bedrooms. All bathrooms were clean, properly supplied and had functional fixtures. Hot water temperature was 115.6 degrees Fahrenheit. Cleaning supplies were kept in locked cabinets. Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit. Smoke Alarms and Carbon Monoxide: detectors were tested and function properly. Fire extinguisher is located in the kitchen with purchase date 11/4/24. Common Areas: These included the living room and dining area. The common areas were properly furnished with adequate couches, chair, and television. The dining area had a large table, to seat up to six (6) individuals. Furniture in common areas were clean and in good repair. Floors were mopped and clean. Hallways and passageways were clear of any obstruction. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. No lock on the side gate. There was furniture appropriate for outdoor use. The backyard has sufficient space to hold outdoor activities. There are no pools or any other bodies of water. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files: LPA was unable to conduct staff file review as there was no physical file for S1, S2 and S3. Medications: Medication and Medication Records were review for proper documentation. Exit interview conducted, citation issued and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Nov 4, 2024

Allegation investigated: The facility retained a resident with a prohibited health condition. Staff did not seek timely medical care for resident.

Licensing Program Analyst (LPA) Mariana Agban met with the Administrator, Florence Peregrino, to conduct an unannounced subsequent complaint visit to deliver the findings regarding the allegations, listed above. An entrance interview was conducted. On 12/06/23, Complaint 31-AS-20231206155759 was received by the Woodland Hills Adult & Senior Care Regional Office. Complaint 31-AS-20231206155759 was referred to the Community Care Licensing Division’s Investigation Branch (IB) on 12/07/23 as an assignment to investigate the complaint. A complete investigation was conducted by IB Investigator, Heidy Bendana, for Case #LD3123-12524. An initial visit was made by Licensing Program Analyst (LPA) Mariana Agban on 12/08/23. LPA conducted a walk through the facility to ensure the health and safety of the resident in care, on this day, no issues were observed. LPA conducted a records review and obtained copies of the Residents' roster, Staff roster, R1’s Admission Agreement, Physician’s Report, and Special Incident Report (SIR) reporting that R1's health condition was declining. Unsubstantiated R1 was receiving wound care under hospice care once a week and a home health nurse twice a week. Staff were repositioned R1 every two hours as instructed by hospice and changed dressing if wet as instructed. Per medical records, R1’s wounds were treated and were not neglected or infected. The progression of R1’s wounds did not indicate neglect or failure to seek medical care. R1 received medical care; therefore, the allegation is deemed Unsubstantiated. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Oct 14, 2024 · control 31-AS-20231206155759