Breeze Hill Care

Allegation investigated: Staff did not complete an initial personal property inventory when resident entered the facility.

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to conduct an investigation into the allegation above. LPA met with the Staff, Evangeline Bartolazo, who was informed of the purpose of the visit. LPA conducted interviews, documented observations and collected documentation for the resident. Regarding allegation " Staff did not complete an initial personal property inventory when resident entered the facility. " It was alleged that the facility staff failed to complete a personal property inventory form for the resident. The LPA reviewed the resident's file and found that the facility did complete this form and obtained a copy of this. When facility staff was interviewed on what belongings the resident came to the facility with, the staff responses were consistent with the personal property form that was filled out. This agency has investigated the complaint and found that the allegation unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with this report was reviewed and provided to them. Unfoundedthe state’s words, verbatim · CDSS document, Aug 9, 2026 · control 18-AS-20230217085412

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced Case Management Visit. LPA met with Staff, Evangeline Bartolazo who was informed on the purpose of the visit. LPA conducted the Case Management Visit to deliver an amended report. LPA read the amended report, met with facility staff, and observed the facility common areas during the time of the visit. No immediate health or safety issues were observed during the time of the visit. No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Aug 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Licensee, Smilja Milosavljevic who was informed of the purpose of the visit. At the time of the visit there was (3) staff and (5) residents present. The facility is a one story home with (5) resident bedrooms, (1) staff room, and (5) bathrooms. No pools or firearms are housed at the facility. The facility is approved for (6) non ambulatory residents, (1) of which may be bedridden. The number of hospice residents during the time of the visit is in compliance with the approved Hospice waiver for (4) residents. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area and passage ways were observed to be free of hazards. LPA observed hygiene supplies for residents, PPE, clean linens. There are designated locked areas for sharps, dangerous objects, cleaning supplies, and medications. The smoke detector and carbon monoxide are operational, and the hot water temperature 120F. There are emergency supplies such as emergency lighting, complete first aide kit and emergency food and water. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed the facility's emergency and disaster plan and infectious control plan. LPA reviewed documentation showing the facility's last fire drill 10/02/2025, which met the department requirements. Required postings were found in the facility. The listed administrator, possesses a current administrator's certificate. LPA reviewed (3) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. (6) resident files were reviewed, and possessed all required paperwork. The facility does not handle finances for residents, per the Licensee. LPA observed resident medications which are locked, filled, and stored in their originally received containers. The medication was accounted for on Centrally Stored Medication logs for residents. No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Dec 2, 2025

Allegation investigated: Staff did not provide proper supervision to resident in care resulting in multiple falls

Licensing Program Analyst (LPA) Janira Arreola conducted an unannouned visit in order to investigation the allegations listed above. LPA met with Staff, Eva Bartolazo and spoke with Administrator Smilja Milosavljevic over the phone who were informed of the purpose of the visit. LPA conducted interviews, observations and records review. It was alleged "Staff did not provide proper supervision to resident in care resulting in multiple falls", regarding Resident #1 (R1) who experiences falls while at the facility due to lack of supervision at night. LPA attempted to conduct interview with R1, however R1 was not available for interview. Substantiated LPA conducted (3) staff interviews which revealed R1 experienced wandering behaviors and experienced a fall occurring after 3 am when R1 got up at night to go to the restroom. All (3) staff interviewed confirmed staff are on call at night and there is no awake staff. Records review revealed physician's report identifying R1 with Condition #1 (C1). There was no readmission appraisal or plan of care on file for R1. According to California Code of Regulations (CCR) Title 22, person's identified with C1 in facilities with (16) residents or less require at least (1) awake staff at night. Therefore, based on interviews and records review the allegation is substantiated. The preponderance of the evidence standard has been met and CCR Title 22 regulation is being cited on the attached LIC9099-D. An exit interview was conducted where this and attached reports including appeal rights were reviewed and provided. Records review revealed medication order for R1's physician stating R1 was prescribed M1 with instructions: "Please give extra dose of M1 at night if patient restless or wanders." Therefore based on records review and interviews the allegation that M1 was being used to sedate R1 in bed and was given incorrectly is unfounded. The allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 8, 2025 · control 18-AS-20250501160911

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(b)(2) · Plan of correction due date: May 9, 2025

Care of Persons with Dementia(b) Licensees shall be responsible for the following: (2) For facilities with fewer than 16 residents, ensuring there is at least one night staff person awake and on duty if any resident with dementia is determined through...observation, to require awake night supervision. This requirment was not met as evidenced by: Based on interview and record review R1 had Condition #1 and the facility was not providing night supervision with awake staff. Based on interview staff were aware R1 had wandering behaviors. This poses an immediate health saftey or personal rights risk to residents in carethe state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: The licensee agreed to submit an updated LIC500 showing staff coverage at night by the POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit and found the below deficiencies. LPA met with Staff, Eva and spoke with Administrator Smilja Milosavljevic over the phone who were informed of the purpose of the visit. LPA conducted interviews, observations and records review. File review for Resident #1 (R1) revealed R1 did not have a preadmission appraisal or plan of care in their file. Interview with the administrator revealed they did not prepare a plan of care for R1 as they were admitted for two and a half months. The deficiency was cited and an exit interview was conducted where a copy of this report with LIC809-D page and appeal rights were reviewed and provided.the state’s words, verbatim · CDSS document, May 8, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c)(1) · Plan of correction due date: May 29, 2025

(c) Prior to admission...(1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition...evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462 Social Factors. Based on interview and record review R1 did not have a preadmission appraisal documented. This poses a potential health saftey or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: The licensee agreed to attend a training on preadmission appraisals and care plans and submit by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Armando Perez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with administrator, Smilja Milosavljevi. The LPA informed the Administrator of the purpose for the visit. The inspection included the following: The facility consists of six (6) resident bedrooms, one staff bedroom, five (5) bathrooms, a kitchen and dinning area, a living room area, a garage and laundry area, a yard with sufficient seating with a table umbrella, and space for activities. There are no bodies of water located on the property. According to Administrator, no weapons are stored in the home. All outdoor and indoor passageways are kept free of obstruction and are free of debris and other trash. There are grab bars for each toilet, bathtub and shower used by residents. Resident showers have non-skid mats present. The home was kept clean and free of any odors. LPA began review of client records. Five (5) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client records to be available and complete. LPA began review of employee records- four (4) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification. Administrator provided proof of submitted application and the completion of all the courses and is pending the certificate. LPA observed personnel records to be available and complete. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for chemicals in the garage. Sharps and knives are locked in the kitchen. Medications are centrally stored. There is a locked cabinet in the kitchen allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers was observed to be in compliance and valid until 12/31/2025. The facility is conducting emergency disaster/fire drills quarterly; last done on 08/21/2024. Based on the information received during this visit today in the areas reviewed, there are no deficiency that are being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809 report was reviewed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Dec 16, 2024

Type of visit: Required - 1 Year

On December 14, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection and met with the Administrator, Smilja Milosavljevic. The LPA introduced herself and stated the purpose of the visit. LPA Mixson toured the facility along with the Administrator and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home, located at 799 Marsopa Drive, Vista, CA. 92081. Physical Plant: The facility phone number is (760) 631-0267 and is operable. The LPA observed the residents bedrooms, and they are equipped with required furniture as per Title 22. The LPA inspected facility bathrooms, and the hot water temperature was tested and tested within regulations. The bathrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as The Ombudsman, "If you See Something, Say Something," and the "Personal Rights" postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the resident and staff files they were locked and inaccessible to residents in care. Medications: were locked and inaccessible to the residents. The overall facility is clean, the furniture is in good condition. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision Facility has sufficient staff, three at the time of this visit, and the residents are busy with the noon day meal. Records Review: The LPA reviewed five resident files, two staff files, and interviewed three staff. There were no Title 22, Division 6 Regulation violations observed and/or cited during today’s visit. An exit interview was conducted and a copy of this report was given to the Administrator, Smilja Milosavljevic.the state’s words, verbatim · CDSS document, Dec 14, 2023