Banner Ridge Country Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Nelia Macasinag, Caregiver and explained the purpose of the visit. At 10:50am, administrator, Elna Villaflor arrived and and assisted LPA with the inspection. The facility is approved to serve residents age range 60 and over, (6) non ambulatory, hospice waiver approved for (6) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained in the proper use of all required PPEs. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Operational Requirements: A fire clearance is in place. Plan of operation and training logs were reviewed. The facility accepts and retains residents with dementia. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 04/02/2026. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (5) bedrooms, (4) of which are resident bedrooms, (1) staff bedroom, (2) bathrooms, living room, formal dining room, family room with fireplace, dining area for residents, kitchen, laundry area, attached garage, and backyard with patio area. LPA observed a stand alone shed converted into a sleeping room for staff. There are currently (3) residents, 60 years and older residing in the facility, (1) is under hospice care. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a bed, linen, light, chair and sufficient closet space. Backyard was inspected. All outdoor and indoor passageways are kept free of obstruction. There are (2) fire extinguishers in the facility purchased on 12/21/2025. There are smoke detectors located in each bedroom and a carbon monoxide detector located in the hallway. There are no firearms or weapons stored at the facility. The hot water temperature was measured between the required range of 105-120 degrees F.*****REPORT CONTINUED ON LIC809-C***** Staffing: A total of (9) caregivers including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Four (4) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings. Administrator has completed the required administrator courses and certificate is valid through 06/05/2026. Resident Rights-Information: Resident personal rights are posted. Facility provides internet services to all residents and have access to the facility phone. Administrator provides initial and ongoing training for staff. Planned Activities: Information regarding Dementia is part of training for direct care staff and is included in the Plan of Operation. The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Pesticides and cleaning supplies are kept away from the food preparation areas. No resident requires modified diet. Incidental Medical Services: Residents' medications were reviewed during the visit. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are stored in a locked cabinet and inaccessible to residents. Resident Records-Incident Reports: Three (3) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Fire and earthquake drill was last conducted on 01/15/2026. Residents with SHN: (1) resident is under hospice care. Physician order for full bed rail was reviewed on the resident's file. There are no residents utilizing oxygen at this time. No deficiency cited. Technical Assistance issued. Exit interview and a copy of this report was provided to the Administrator, Elna Villaflor.the state’s words, verbatim · CDSS document, Feb 10, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility did not have a volunteer screened for Tuberculosis prior to providing care and supervision to residents.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced and met with Administrator, Elna Villaflor. The reason for the visit was explained. During the visit today, LPA toured the facility and obtained copies of the resident and staff rosters. LPA also reviewed personnel files and interviewed the administrator and two Staff. Allegation - Facility did not have a volunteer screened for Tuberculosis prior to providing care and supervision to residents. It is alleged that a volunteer was allowed to work with residents without having a TB clearance. LPA interviewed the administrator and two Staff. Administrator Villaflor stated that staff are required to have a health screening and TB testing when they are hired. She stated that the volunteer (staff #1) worked only a few days sometime in November of 2024. During that time, Staff #1 was sent to get a health screening and TB test, but never returned to work after. Unsubstantiated LPA interviewed an additional two staff. Both staff stated they had gotten a health screening and TB test results before working at the facility. One of the staff stated that Staff #1 was shadowing for about 3 days and stopped working. Staff #1 is no longer working at the facility and was not available for an interview. LPA reviewed current personnel files and observed TB test results and/or chest x-ray at the time of hire. According to Title 22 regulations, 87411(f) "....Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure." Based on the information gathered, there is insufficient evidence to prove this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with the administrator. A copy of this report, along with the appeal rights, was provided.the state’s words, verbatim · CDSS document, Apr 25, 2025 · control 28-AS-20250421112759

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 12/6/24. LPA met with Staff, Raquel Salen, and explained the purpose for the visit. Administrator, Elna Villaflor, arrived to assist with the visit. The facility is licensed to serve (6) non-ambulatory residents, ages 60 and over. There is an approved hospice waiver for 6 residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) Tools to inspect the home. The facility has 5 resident bedrooms, 2 bathrooms, living room, 2 dining areas, family room, kitchen, laundry room, and an attached garage. The hot water temperature was measured between the required range of 105-120 degrees F. There are no swimming pool or bodies of water on the premises. The fireplace is adequately screened. There are smoke detectors located in each bedroom and a carbon monoxide detector located in the hallway. Disinfectant, cleaning solutions, knives are locked and inaccessible to residents. There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The kitchen is kept clean and free of insects and vermin. The facility accepts and retains residents with dementia. There are no residents utilizing oxygen at this time. Facility has the required amount of liability insurance. Facility staff are continuing to follow the Infection Control Plan and using appropriate hand hygiene while providing care. Per the licensee, there is sufficient staffing at the facility. Staff employed have fingerprint clearance and associated to the facility. LPA reviewed 3 staff files and files have current CPR & first aid certificate. Resident files are maintained at the facility and have the following documents in their files. Medications were reviewed for all 5 residents and no discrepancies were observed. The Complaint poster, Local Ombudsman, and Residents personal rights are posted. Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical/mental capability. The facility has an Emergency Disaster Plan easily accessible with contact numbers and at least 2 relocation sites. Facility conducts disaster drills. No deficiencies were issued today. An exit interview was held. A copy of this report was given to E.Villaflor.the state’s words, verbatim · CDSS document, Dec 6, 2024

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspection. LPA arrived unannounced and met with staff, Raquel Salen. Administrator, Elna Villaflor arrived shortly after. The initial inspection was conducted on 1/12/24. LPA conducted the remainder of the domains using the CARE tool and observed the following: Staffing: There is sufficient staffing at the facility. Staff employed have fingerprint clearance and associated to the facility. Personnel Records-Training: Staff files are maintained at the facility. Staff have current CPR/first aid training and sufficient on-going training that meet the annual requirement. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Physician's Report, and Resident rights. Resident Rights-Information: The Complaint poster, Local Ombudsman, and Residents personal rights are posted. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical/mental capability. Incidental Medical & Dental: Medications are centrally stored and in their original bubble packs. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed all 4 residents' medications and they are being administered as prescribed by the physician. Disaster Preparedness: The facility has an Emergency Disaster Plan easily accessible with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. Staff training include proper care and supervision for residents with dementia. No deficiencies were issued today. However, technical advisories were provided. An exit interview was held. A copy of this report and technical advisory notes were given to the administrator.the state’s words, verbatim · CDSS document, Jan 19, 2024

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 1/12/24. LPA arrived unannounced and met with Staff, Raquel Salen. The purpose of the visit was explained. Administrator, Elna Villaflor, arrived to assist with the visit. The facility is licensed to serve (6) non-ambulatory residents, ages 60 and over. There is an approved hospice waiver for 1 resident. LPA utilized the Compliance and Regulatory Enforcement (CARE) Tools to inspect the home. The following were observed: Infection Control: The facility has submitted an Infection Control Plan. Staff are continuing to clean and disinfect the home. They are using appropriate hand hygiene and wearing gloves while assisting residents. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are no residents utilizing oxygen at this time. Facility has the required amount of liability insurance coverage. Physical Plant & Environment Safety: The facility has 5 resident rooms, living room, dining area, family room, kitchen, 2 bathrooms, and attached garage. The hot water temperature was measured between the required range of 105-120 degrees F. There are no swimming pool or bodies of water on the premises. The fireplace is adequately screened. There are smoke detectors located in each bedroom and a carbon monoxide detector located in the hallway. Disinfectant, cleaning solutions, knives are locked and inaccessible to residents. Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The foods are properly stored in the refrigerator. The kitchen is kept clean and free of insects and vermin. LPA will continue with the remainder of the domains at a later date. No deficiencies are issued today. An exit interview was held and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Jan 12, 2024