Brigitte's Villa Regina Home

Type of visit: Required - 1 Year

On September 22, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (ADMIN) Mark Fisk and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for four (4) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, one (1) Staff Bedroom, four (4) bathrooms, living area, dining area, kitchen, outdoor covered patio area, and an attached two car garage. LPA Kim toured inside and outside of the physical plant . There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Resident Room 5, and Resident Room 6 Bathrooms were clean and operational. The water temperature measured between 133.7 degrees F to 136.5 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the laundry room and kitchen pantry. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (949) 998-9191 remains available. First Aid kit had all the necessary elements. The facility has one (1) fire extinguisher that was charged, mounted in the kitchen that was serviced on October 1, 2024. Evidence of liability insurance waseffective July 20, 2025, to July 20, 2026 LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S2), and medication and medication administration record that were all in order and complete. LPA Kim conducted interviews with two (2) staff and three (3) residents. A deficiency was cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed the water temperature in resident bathroom #1 (R1) measured at 133.7 degrees F and the shared residents bathroom at 136.6 degrees F. POC was cleared during the visit, Licensee adjusted the water temperature where R1's bathroom hot water measured at 105.2 degrees F and the shared residents bathroom measured at 105.8 degrees F. An exit interview was conducted, and a copy of this report, LIC811, the Letter of Deficiency Citation Cleared, and appeal rights were provided to Administrator Mark Fisk.the state’s words, verbatim · CDSS document, Sep 22, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs) Jessica Cho and Edward Kim arrived unannounced to issue an amended deficiency on a citation issued during the last annual inspection conducted on September 11, 2024 from 7am-12:20pm. LPAs were greeted and granted entry by Caregiver Cristy Lucero. Administrator Mark was immediately informed by telephone and arrived on site at 12:42pm and was explained the reason for the visit. Previous Type B 87456(a)(3) deficiency was cited incorrectly. The correct deficiency will be cited today on the attached LIC809-D as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrator Mark Fisk, and a copy of this report including the LIC809-D, LIC811, and the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Apr 2, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(h) · Plan of correction due date: Apr 9, 2025

87463 Reappraisals (h)The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. This requirement was not met as evidenced by: Based on LPAs' observations and record review conducted during the annual inspection on 9/11/24, administrator did not obtain a recent medical for one out of the six residents in care which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 2, 2025

Plan of correction: Administrators stated that the proof of R6's physician's report and the Acknowledgement of Understanding of regulation 87463 Reappraisals will be submitted to LPA via email by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Jessica Cho, Jerome Haley, Samer Haddadin arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPAs were greeted by Caregiver Cristy Lucero and were granted entry. Administrator Mark Fisk arrived on premise approximately 8:15am and Erin Fisk arrived shortly after. The Administrator's Certificate for Mark Fisk expires on January 27, 2026 Facility is licensed to serve six (6) non-ambulatory residents and maintains an approved hospice waiver of (4) residents. There are six (6) residents in care during today's visit with two (2) caregivers on duty. LPAs conducted a tour of the physical plant. This is a single story home in a residential neighborhood. The facility consists of six resident bedrooms and four resident bathrooms. There is an additional bedroom occupied by two live-in caregivers. LPAs inspected all common areas including the garage. The garage door was observed to be locked and LPAs were not allowed access into the garage. After several discussions with Administrators Mark and Erin of ensuring LPAs having full access within the property line, LPAs were allowed entry approximately 9:40am. LPA Haley and Haddin observed the garage was filled with clutter. Photographs were taken. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for personal belongings were observed. Bathrooms were found to be clean, sanitary, and operational. The water temperature measured at 118.5, 118.4, 118.7, and 115.8 degrees Fahrenheit. Toxins and disinfectants were unsecured in a pail under the dresser in the hallway. Medications were secured and inaccessible. LPAs observed sufficient two day supply of perishables and seven day supply of non-perishable food. Caregiver #1 (C1) was reminded to label the expiration dates of the pantry items in lieu of the opening date. LPAs toured the exterior portion of the facility. LPAs observed the outdoor passageway. Admins cleared the two bicycles that were obstructing the passageway as well as the shovel and metal bar. LPAs observed sufficient seating and shading. There was no body of water. Facility maintains a fire extinguisher which was mounted, charged, and serviced on October 4, 2023. The auditory devices and smoke/carbon monoxide detectors were tested and operational. LPAs observed sufficient PPE and emergency disaster supplies including food/water. Emergency evacuation drills are conducted quarterly and facility is maintaining a log documenting the drills. The first aid kit contains all necessary elements. LPA observed the required 'See Something, Say Something' (PUB475) poster in the correct size posted in the entry way. Facility maintains a current liability insurance. A working facility telephone number, (949)-998-9191, was tested and remains available. LPAs conducted an audit of six residents' files and two personnel files. A discrepancy was noted for Resident #6 (R6). Medications were audited for six residents. No discrepancies noted. Staff and resident interviews were also conducted. The following items were consulted with Administrator Mark and Erin: to ensure LPA(s) have full access within the property line moving forward, to post the No-Smoking, Oxygen in use sign on the front door and bedroom door for Resident #5 (R5), to ensure disinfectants are secured and inaccessible to all residents, to remove the clutter in the garage, and to update the physician's report for Resident #6 (R6). Based on the observations made during today's visit, deficiencies are being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. See the attached LIC9099-Ds. Advisory Notes are also being issued. An exit interview was conducted with Administrators Mark and Erin Fisk, and a copy of this report including the LIC9099-C & Ds, LIC421IM, Advisories, and the Appeal Rights were provided at exit.the state’s words, verbatim · CDSS document, Sep 11, 2024

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.