Blue Skies of the Valley

Allegation investigated: Licensee did not meet resident's hygiene needs Resident was confined to their room

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above mentioned allegations. LPA was greeted by, identified herself to, and explained the purpose of the visit to Caregiver William Punta. During today’s visit, LPA observed residents in care and interviewed staff. The Department’s investigation consisted of interviews with residents and staff, records review, and a tour of the facility. It was alleged that the Licensee did not meet resident’s hygiene needs and Resident 1 (R1) was confined to their room. Continued on LIC9099-C page... Unsubstantiated Review of assessment records for R1 revealed that R1 required assistance with bathing and hygiene care, and further assessment of the other resident’s assessment records revealed that a total of four of six residents requires assistance with hygiene and bathing care. Interviews with residents did not reveal any concerns that staff did not assist residents with showering and residents were pleased about the frequency of staff assistance with showers. Interviews with staff showed that coordination between facility staff and outside agencies allowed residents to receive showers as often as every other calendar day. Interviews with staff did reveal that at least one resident was resistant to receiving shower assistance by staff of the opposite gender, however, staffing schedules allowed for the resident to receive showers by their preferred staff. LPA observations during on-site visits did not reveal any noticeable odors or concerns that residents were not well groomed or appropriately dressed. Additionally, LPA observed that staff assisted residents with incontinence care and ensured that residents were well groomed and absent from noticeable odors following the incontinence care. Additionally, interviews with staff and residents did not reveal concerns that residents were not able to move about the facility as they wished, including entering the facility’s backyard. Interviews with R1 did not reveal any concerns that R1 was not able to leave their room if they wished. LPA observed during on-site visits that residents, including R1, were able to leave their rooms as desired. However, there was some evidence that residents were not allowed to enter the facility’s kitchen during certain times. Interviews with staff revealed that residents were not allowed to enter a portion of the kitchen where locked cabinets containing sharps and/or other hazardous items were stored. On-site visits confirmed that those items were kept in locked storage as required. The Department has investigated the above-mentioned allegations and based on observation, interviews, and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated. An exit interview was conducted with Caregiver William Punta, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).the state’s words, verbatim · CDSS document, Dec 30, 2025 · control 08-AS-20251119162238

Allegation investigated: Lack of Supervision, resulting in hospitalization

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Caregiver William Punta. The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that lack of supervision resulted in the hospitalization of Resident 1 (R1). Interviews with staff and outside sources and review of medical paperwork revealed that R1 moved into the facility on 5/17/2025 following an admission to a skilled nursing facility. According to R1’s medical and pre-admission assessment documents, R1 was assessed to require the use of a wheelchair, staff assistance with all activities of daily living, and assistance with medication management. Continued on LIC9099-C page... Unsubstantiated Interviews revealed that on 5/20/2025, three days following R1’s admission to the facility, R1 was observed to have a change in condition, which resulted in emergency services being contacted and R1 was transported to the hospital. Medical records from R1’s hospitalization showed that toxicology results revealed that R1’s urine analysis was positive for fentanyl. Review of R1’s medical records revealed that R1 was not administered fentanyl during emergency services transport or while at the hospital prior to the toxicology test. Review of the medication lists for all residents at the facility, including for R1, did not reveal any medications that contained fentanyl. During interviews, staff denied any knowledge of the existence of any medications containing fentanyl in the facility, including medications prescribed to live-in staff. Staff also denied knowledge of how R1 could have been exposed to fentanyl while at the facility. Review of R1’s toxicology report confirmed that medications of a similar chemical structure to fentanyl could cause a false positive on testing. Interviews with medical professionals denied that any of R1’s prescribed medications could cause a false positive for fentanyl. Clinical consultants of the Department also reviewed R1’s medications and confirmed that none of R1’s prescribed medications could cause a false positive for fentanyl. Additionally, medical professionals stated that fentanyl is generally prescribed in patches applied to the skin and other forms of administration such as liquids or pills are rarely prescribed. R1’s toxicology report stated that the test was “unconfirmed screening results” used to assist in managing medical care and additional testing would need to be done to confirm the result. Review of R1’s medical records did not reveal any evidence that confirmatory testing was ordered to verify if the test was accurate. The Department has investigated the above-mentioned allegation and based on interviews and records review showing a lack of evidence of mismanagement of medications and a lack of explanation of how R1 tested positive for fentanyl, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with Caregiver William Punta, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).the state’s words, verbatim · CDSS document, Dec 30, 2025 · control 08-AS-20250523102111

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver William Punta. During today's visit, LPA observed residents in care and reviewed facility records. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. No deficiencies were cited on today’s date. An exit interview was conducted with Caregiver William Punta, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Dec 30, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to finish the annual inspection from 2/26/2025. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Caesar Tapit. The facility is licensed for a maximum capacity of 6 residents, 4 ambulatory and 2 non-ambulatory in bedroom # 5. The facility has a waiver for 6 hospice residents. During today’s visit, the facility had a census of 4 non-ambulatory residents, 1 of which was bedridden. During the Required 1-year visit on 2/26/2025, LPA Borunda cited the facility for the fire clearance violation and the facility has a pending capacity increase to address the fire clearance violation. The Administrator for the facility is Laurice Gamab and their certificate was valid and current. During visits on 2/26/2025 and 3/12/2025, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 111.0 and 112.6 degrees Fahrenheit in bathrooms for resident use. The facility’s internal temperature was measured at 78 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Caesar Tapit, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 37 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Continued on LIC809-C page… Staff present at the facility during the time of the inspection had a criminal background clearance and at least one staff had a first aid certificate. LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property, and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and residents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns. The Administrator will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, and current liability insurance to the Department within 15 business days. During the facility tour, LPA did not observe any grab bars in the shower in the common bathroom. Caregiver Tapit stated that staff currently shower residents in the facility's private bathroom due to the private bedroom being empty. LPA advised Caregiver that when the bedroom is occupied, staff could not shower any residents that did not reside in the attached bedroom in the private bathroom. Therefore, the following deficiency was cited for missing grab bars and noted on the attached LIC809-D page. An exit interview was conducted with Caregiver Caesar Tapit, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Mar 12, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Jemela Magulod. LPA spoke with House Manager Lauren DeLancey via telephone. During today's visit, LPA briefly toured the facility, reviewed facility records, and observed residents in care. The facility is licensed for a maximum capacity of 6 residents, 4 of which may be ambulatory and 2 of which may be non-ambulatory in bedroom #5. Review of all residents' medical assessment and appraisal records revealed that 5 of 6 residents (R2, R3, R4, R5, and R6) had a diagnosis of major neuro-cognitive disorder and 5 of 6 residents (R1, R2, R3, R5, and R6) required the use of mechanical aid devices to ambulate, such as walkers and wheelchairs. [Caregiver was provided with an LIC811 Confidential Names List to identify residents] Interviews with facility staff revealed that R4 and R5 are bedridden and unable to get out of bed. LPA confirmed residents' use of mechanical aids via interviews with staff. The diagnosis of major neuro-cognitive disorder and the use of mechanical aids to ambulate revealed that R1, R2, R3, and R6 are non-ambulatory and R4 and R5 are bedridden, which is violation of the facility's fire clearance approved on 3/11/2024. The following deficiency for fire clearance is noted on the attached LIC809-D page. Additionally, an immediate civil penalty in the amount of $500 is assessed and noted on the LIC421IM form. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. An exit interview was conducted with Caregiver Jemela Magulod, whose signature below confirms receipt of a copy of this report, the LIC421IM, LIC811, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Feb 26, 2025

Type of visit: Collateral

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced collateral visit to conduct a resident interview. The LPA introduced himself to Caregiver Jemela Magulod, and disclosed to the purpose of the visit. Review of records and an interview with Magulod revealed Resident # 1 (R1) did not reside at the facility. An exit interview was conducted with Caregiver Magulod, to whom a copy of this report, and Licensee/Appeal Rights, were provided.the state’s words, verbatim · CDSS document, Apr 10, 2024

Type of visit: Collateral

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced collateral visit to conduct a resident interview. The LPA introduced himself, and disclosed to the purpose of the visit to Manager Lauren Delancey. During the visit, the LPA reviewed records and interviewed Resident # 1 (R1). An exit interview was conducted with Manager Delancey, to whom a copy of this report, and Licensee/Appeal Rights, were provided.the state’s words, verbatim · CDSS document, Apr 10, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit due to a request to change the facility capacity. LPA was greeted by, identified herself to, and discussed the purpose of the visit with House Manager Lauren DeLancey. A Change of Capacity application was received by the Department on February 2, 2024, in which the licensee requested an increase in non-ambulatory capacity from 0 to 2 residents. The Fire Safety Inspection Request was approved by the local fire authority on March 11, 2024 with the requirement that the 2 non-ambulatory residents will reside in the room noted Bedroom #5 on the facility sketch. During today’s visit, LPA toured the facility and inspected each room. No residents were admitted to the facility at the time of LPA's inspection. The facility sketch was consistent with the current layout of the facility. No immediate health and/or safety concerns were observed during today's visit. The completed change of capacity request will be forwarded to management for final review and approval. An exit interview was conducted with House Manager Lauren DeLancey, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Mar 27, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Dang Nguyen conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified himself to, and explained the purpose of the visit to the applicant’s representatives, Hanh Le Dao and Lauren Delancey. The facility fire clearance was granted on 12/27/2023 and reflected that the facility was approved for six (6) residents in total, of which all must be ambulatory. The facility's fire clearance did not include delayed-egress door or secured perimeter endorsements, and neither were present during today's visit. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPA, accompanied by the applicant’s representatives, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was compliant at 72 degrees F. Hot water temperature at taps accessible to residents were also compliant: Kitchen sink was 117 F, Bathroom #1 sink was 114.6 F, Bathroom #2 sink was 118.4 F, and Laundry Room sink was 119 F. The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order. Refrigerator temperature was 37 F, and freezer temperature was 0 F. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant’s representatives, no firearms or ammunition are or will be stored at the facility. Smoke alarms, carbon monoxide detector, emergency lighting, and facility telephone were all operational. The facility's fire extinguisher was serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. Le Dao was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant’s representative, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jan 23, 2024