Cerritos Villa 1

Allegation investigated: Staff admitted a resident with a prohibited health condition Staff mishandled a resident's medication Staff did not ensure a resident was properly fed

Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint visit regarding the allegations listed above. LPA arrived unannounced and met with Staff S1. The purpose of the visit was explained. Administrator, Julio Navallo, arrived shortly after. The initial visit was conducted on 07/29/25 and included the following: LPA reviewed Resident R1's file and the facility to submit resident roster, staff roster, and documents pertaining to Resident (R1). LPA toured the facility and interviewed the assistant administrator telephonically. Resident R2 was interviewed at today's visit. Attempts were made to interview Resident R3 were unsuccessful with R3 unable to respond to questioning Resident R1 was in the hospital as of 7/28/25. At today's visit 11/06/25 Resident R2 and R3 were interviewed. Attempts were made to interview Resident R4 and R5 were unsuccessful with both residents unable to respond to questioning. . Unsubstantiated It should be noted that Resident R1 passed away on 08/05/25. Hospice chart was reviewed in regards to Resident R1. Staff S1-S3 were interviewed. In regards to the allegation Staff admitted a resident with a prohibited health condition, based on interviews conducted and information gathered it was revealed by family member of Resident R1 that there was never wrong doing by the facility and they did a good job providing care. Stated the complaint is with the Hospice agency. R1 was admitted to the facility on 7/9/23 with hospice services for the gastrostomy (G) tube. Per the administrator and facility staff, R1 is provided food and medications through the G tube. Interview with Assistant Administrator who stated that staff are trained on how to assist the resident on the g-tube. They only give the formula via g-tube (about 5 cartons a day) and then flush it after the feeding to clean the tube. The staff do not replace the dressing. Stated that hospice nurse trained them on what to do and gave instructions to the staff in the beginning. (LPA observed Staff Training Certificates in regards to G-Tube Training). Administrator stated they have a Hospice Care Plan regarding Resident R1. Stated that Hospice supervised staff regarding the G-Tube. If any emergency issues Hospice is called immediately. Staff S1-S3 stated that they all had training regarding G-Tube Care. Said the G-Tube for Resident R1 would clog and as instructed they would try to flush it with water and if still clogged they call Hospice immediately. Hospice Visit Notes state on 10/29/24 G-Tube cleared and changed with new dressing. On 11/02/24 G-Tube clogged. 11/04/24- Medical doctor aware of G-Tube replacement. 11/26/24 g-tube not working. Can not aspirate or flush. Will follow up. On 12/03/24 G Tube dressing changed. G Tube clogged. Follow Up on G-Tube replacement. Interviews with Resident's R2 and R3 both stated staff treat them well and they are getting great care and staff will assist them with whatever they may need assistance with. 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. In regards to the allegation Staff mishandled a resident's medication, based on interviews conducted and information gathered it was revealed by the family member of Resident R1 that staff did a good job taking care of R1. Said he was satisfied with R1 being fed and given medications. Stated his issue is with Hospice Agency and not the facility. Staff S1- S3 stated that staff will give meds through the tube. When it gets clogged, they were instructed to put some warm water on syringe and then flush it. If the tube has been clogging the hospice nurse is made aware of it and will assist Resident R1. Administrator stated that staff all had in-service G-Tube training. Hospice supervised staff on feeding and medication administered. If emergency will call Hospice immediately. Assistant Administrator stated that Resident R1's family member had talked to her about filing a complaint on the hospice agency. Also stated that the staff are trained on how to assist the resident on the g-tube. They only give the formula via g-tube (about 5 cartons a day) and then flush it after the feeding to clean the tube. The staff do not replace the dressing. Stated that the Hospice nurse taught them what to do and gave instructions to the staff in the beginning. Hospice Visit Notes state on 10/29/24 G-Tube cleared and changed with new dressing. On 11/02/24 G-Tube clogged. 11/04/24- Medical doctor aware of G-Tube replacement. 11/26/24 G-tube not working. Can not aspirate or flush. Will follow up. On 12/03/24 G Tube dressing changed. G Tube clogged. Follow Up on G-Tube replacement. Interviews with Resident's R2 and R3 both stated staff treat them well and they are getting great care and staff will assist them with whatever they may need assistance with including medication and meals. 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. In regards to the allegation Staff did not ensure a resident was properly fed, based on interviews conducted and information gathered it was revealed by family member of Resident R1 that there was never wrong doing by the facility and they did a good job providing care. Stated the complaint is with the Hospice agency. Also stated that he was here often at the facility and Resident R1 was always fed and administered medication properly. Administrator stated that they follow the care plan for Resident R1 since using a G-tube. Staff do not change the dressing. They are instructed to notify the hospice agency if the dressing is soiled or has a smell. They are only feeding the formula through the G-tube and flushing/cleaning it right after. Assistant Administrator stated that staff are trained on how to assist the resident on the G-tube. They only give the formula via G-tube (about 5 cartons a day) and then flush it after the feeding to clean the tube. The staff do not replace the dressing. Stated that the Hospice nurse trained them on feeding. Staff S1-S3 stated they check Resident R1's G- tube every time to see if it is ok. The hospice nurse had instructed staff what to do and how to properly clean the tube. Stated they put the milk in the bag and when the feeding is done, they add water to flush it out and remove the tube for cleaning. Hospice Visit Notes state on 10/29/24 G-Tube cleared and changed with new dressing. On 11/02/24 G-Tube clogged. 11/04/24- Medical doctor aware of G-Tube replacement. 11/26/24 G-tube not working. Can not aspirate or flush. Will follow up. On 12/03/24 G Tube dressing changed. G Tube clogged. Follow Up on G-Tube replacement. 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.the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 28-AS-20250723191517

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced annual visit today. LPA met with Julio Navallo, Administrator, and the reason for the visit was explained. The facility is licensed to serve elderly residents age range 60 and above. All can be non-ambulatory. Facility is fire cleared for one bedridden resident; facility is approved to accept and retain (1) resident on Hospice. Facility is 87705 compliant; twenty -our hour awake staff required. The facility is operating within the scope of its license. The facility is in a residential area of Cerritos. The single-story home consists of living room, dining area, kitchen, (4) resident bedrooms, (1) staff storage room, (2) full bathrooms, front and backyard/patio area and attached garage/laundry area. During today’s visit, LPA toured the home and observed the following: Facility was observed clean inside and out. Walkways, passages and exists are free of debris and obstructions. Living room and dining area have sufficient seating for residents and furniture is in good repair. Kitchen appliances were observed clean and operable; however, kitchen cabinets were observed stained with grease mildew and dust on the doors and shelves. Also observed, tiles around kitchen sink are cracked and held down with duct tape. Facility has sufficient 2-day perishable and 7-day non-perishable supply of food which is kept labeled and properly stored. Sharps/knives and cleaning supplies are kept locked in a kitchen cabinet under the sink and in are inaccessible to residents. Bedrooms were observed clean and have the required furnishing and bedding. Extra linen is kept in cabinets in the hallway near the bedrooms. Both bathrooms were also observed clean and sanitary. Water temperature was tested in both bathrooms and measured at 111.5 and 105.2 degrees F, which is within compliance range. Fire place is covered and all exits doors have safety chimes which were tested and working properly. ***Continues on LIC 809-C The front and backyard are well maintained, and backyard has a shaded patio area and patio furniture is in good repair. Garage is kept clean and detergents and other toxins are kept locked. Laundry appliances are in good repair and were observed to be working properly. No pools or other bodies of water were observed. During visit, (4) resident and (4) staff files were reviewed. Resident files contain admission agreements, Physician Reports, medical/functional assessments, Appraisals/Needs and Services Plans, TB clearance, personal rights and consent forms and approved Hospice care plan for (1) resident. Staff files contain up to date First Aid/CPR certification, health screenings, criminal background clearances and training documentation. Resident medication was reviewed and found to be administered according to physicians’ orders and documented accordingly. Medication is centrally stored, locked and inaccessible to clients. Facility keeps PPE supplies in the garage. Emergency and Disaster Plan (LIC 610-D) was reviewed and is up to date. Facility conducts safety/fire drills quarterly. Last drill was conducted on 10/13/25 with staff and client participation. Facility has a fire extinguisher in the main hallway and was observed charged and operable. Smoke and carbon monoxide detectors were tested and were working properly. Facility has a current liability insurance policy in place. During today’s visit, deficiencies is noted and citations issued, per California Code of Regulations, Title 22, and California Health and Safety Code. Exit interview was conducted with Julio Navallo, Administrator, and a copy of the report and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Oct 18, 2025

Allegation investigated: Staff did not issue a refund to resident's responsible party

Licensing Program Analysts (LPAs) Erik Zaragoza and Gabriela Castro conducted an initial unannounced complaint visit to address the allegation listed above. LPAs met with Eppi Vencer, caregiver for the facility, and explained the purpose of the visit. Administrator Julio Navallo arrived shortly thereafter. The investigation consisted of the following: LPAs obtained the admissions agreement, pre-placement appraisal, physician's report, and FACE sheet for Resident #1 (R1), and interviewed Staff #1 - 2 (S1 - S2). The investigation revealed the following: In regards to the allegation that "Staff did not issue a refund to resident's responsible party," it is alleged that the responsible party of C1 had paid rent for the entire month of August 2025, and has not received a refund following C1's passing on 8/4/2025. Substantiated During the interview with S1, they explained that S2 is in charge of the finances of the facility and is working to arrange the refund for R1's responsible party, however they had been on vacation and are still processing the refund. During interview with S2, they confirmed that they had been on vacation and is still working to determine what the prorated refund for R1's responsible party will be. S2 additionally stated that R1's personal belongings had been removed from the room one (1) or two (2) days after they had passed on 8/4/2025. During record review of R1's admission agreement, it explains that a prorated refund will be issued to the resident's responsible party after the resident's personal belongings are removed from the facility. Based on the Health and Safety Code, the refund of any fees paid in advance for a resident that has passed away shall be issued to the resident's responsible party within fifteen (15) days after the personal property is removed. S2 informed LPAs that the refund will be issued to R1's responsible party on Monday 9/29/2025. Based on LPA interviews conducted with the residents and staff, the preponderance of evidence standard has been met for the above allegations, therefore the allegation is found to be SUBSTANTIATED. California Health and Safety Code, Chapter 3.2 Article 6 is being cited on the attached LIC9099D page. Exit interview was held and a copy of the report along with the appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 25, 2025 · control 28-AS-20250922154228

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Oct 2, 2025

(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual (...) contractually responsible for the fees (...) within 15 days after the personal property is removed. This requrement was not met as evidenced by: Based on record review and interview, the facility has not issued a refund to R1's responsible party within 15 days, which poses a potential risk the health, safety, or personal rights of persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Licensee/adminisrator is to certfy a plan to address when a refund will be issued to R1's responsible party and provide proof of the refund to R1's responsible party no later than 10/2/2025, via email to LPA Zaragoza.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Erik Zaragoza and Gabriela Castro conducted a case management visit in conjunction with a complaint that has the control #28-AS-20250922154228. During record review of the Serious Incident Reports (SIRs) received by the facility, LPAs determined that no death reports have been received for Client #1 (C1) identified in the complaint, who passed away on 8/4/2025. During interviews with S1, they explained that they have not faxed the death report for C1, nor for two (2) additional residents, because they were under the impression that a death report was not required to be sent to the department if the resident passed away in the hospital or was on hospice. LPAs advised that death reports will still have to be faxed to the department in such cases. The related deficiency is cited on the LIC809D page. A copy of this report along with the appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 25, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Oct 10, 2025

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including (...) (1) A written report (...) within seven days of the occurance of (...) (A) Death of any resident from any cause regardless of where the death occurred. This regulation is not met as evidenced by: Based on record review, LPAs determined that death the facility has not submitted three (3) death reports for three (3) residents who passed away since August of 2025, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator is to ensure that death reports are faxed to the department within seven days of occurance at all times. Administrator is to fax or email the death reports for the 3 residents to the LPA by the POC due date.

Allegation investigated: Staff do not ensure care plan for resident is being followed.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegation listed above. LPA arrived unannounced and met with Staff, Cristina Riego. The purpose of the visit was explained. Administrator, Julio Navallo, arrived shortly after to assist with the visit. LPA obtained a copy of the resident roster, staff roster, and documents pertaining to Resident #1 (R1). LPA toured the facility and interviewed the administrator, 4 Staff, family member, hospice nurse, and R1. For allegation, Staff do not ensure care plan for resident is being followed. It is alleged that Resident #1’s G-tube was clogged due to facility staff not providing the appropriate care. LPA reviewed R1’s file, medical records, and hospice care plan which indicated the reportable conditions pertaining to the G tube complications. R1 was admitted to the facility on 7/9/23 with hospice services for the gastrostomy (G) tube. Unsubstantiated Per the administrator and facility staff, R1 is provided food and medications through the G tube. Staff stated they have received training on how to properly flush out the G tube after feeding and clean it. They stated the hospice nurse is responsible for changing the dressing on the G tube. They also stated they contact the hospice agency to report any issues they come across. Per staff, the G tube had been clogging lately and reported the issue to the hospice nurse, resulting in R1’s G tube being replaced. LPA interviewed the hospice nurse who confirmed that facility staff had been contacting them for any concerns/issues they have on R1. Hospice nurse stated that the G tube had been replaced several times but was not due to facility staff not providing appropriate care. LPA also interviewed R1’s family member who does not have concerns with the care provided by the facility. 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 held. A copy of this report along with the appeal rights was provided to C. Riego.the state’s words, verbatim · CDSS document, Dec 10, 2024 · control 28-AS-20241204083016

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christian Gutierrez conducted a case management visit the purpose of this visit was to discuss documentation that had been submitted to LPA that was altered and or falsified. LPA met with Administrator Julio Navallo. LPA received proof of corrections (POC) on 11/3/2024 for an annual visit conducted on 11/2/2024 that looked altered after verification it was discovered that S2-S3 CPR training had been falsified, staff training document were falsified and R6 physicians report had been falsified. LPA contacted Co-Administrator Maria Navallo on 11/6/2024 that stated that she didn’t not know how that happened and it must have been the staff. LPA tried contacting staff but has yet to receive a phone call back. Deficiencies pertaining to Administrator Qualifications and prohibited health conditions are being cited on the attached LIC809D under the Title 22 California Code of Regulations, Division 6 Chapter 8. Exit interview conducted with Administrator Julio Navallo. A copy of this report is being provided and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Nov 14, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(D)(5) · Plan of correction due date: Nov 21, 2024

87405(d)(5) Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (5) Good character and a continuing reputation of personal integrity. This requirement has not been met as evidenced by: Verification of staff CPR training, staff course training and physicians report for R6 submitted to LPA by Administrator were verified to be falsified and altered.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Administrator will call board meeting to discuss this issue. Administrator states he takes full responsibility and will ensure all training and POC’s are cleared by him. Administrator will have head caregiver assist with training logs. Administrator will call board meeting to discuss this issue. Administrator states he takes full responsibility and will ensure all training and POC’s are cleared by him. Administrator will have head caregiver assist with training logs.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87633(b)(4) · Plan of correction due date: Nov 21, 2024

87633(b)(4) Hospice Care of Terminally Ill Residents (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (4) A description of the area of licensee’s responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident’s physician, and the resident’s responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by the facility. This requirement has not been met as evidenced by: Facility did not have a current care plane for R2 for prohibited health condition.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Administrator will submit a current care plan for R2 along with the responsibly of the facility of how to care for resident with a prohibit health condition,

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(f)(1) · Plan of correction due date: Nov 21, 2024

87633(f)(1) Hospice Care of Terminally Ill Residents (f)The licensee shall maintain a record of all hospice-related training provided to the licensee or facility personnel for a period of three years. This record shall be available for review by the Department. (1) The record of each training session shall specify the names and credentials of the trainer, the persons in attendance, the subject matter covered, and the date and duration of the training session. This requirement has not been met as evidenced by: Based on record review all staff had no training for prohibited health conditions.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Administrator will send LPA training for staff by POC due date.

Type of visit: Required - 1 Year

LPA was met by Caregiver Gloria Roxas and explained the purpose of the visit. Administrator Julio Navallo arrived shortly. Facility is licensed to serve residents over 60 years old six (6) can be non-ambulatory, of which one (1) may be bedridden and one (1) hospice approved. During today’s visit it was observed facility had two (2) bedridden residents without approved fire clearance civil penalties assessed. The home is located in a residential neighborhood, is a single-story home on a cul-de-sac The home contains (4) bedrooms, (2) bathrooms, living room, dining room, kitchen, and garage. LPA toured the facility and observed the following: Each resident’s bedroom has the required furniture and bedding. There is extra clean linen and towels in a hallway closet. Front door auditory device was not working at time of visit. Smoke detectors were observed in each room and throughout the facility and are properly operating. There is 1 carbon monoxide in the hallway and is properly operating. The facility has two (2) fully charged fire extinguishers which is kept in the kitchen and hall. Cleaning supplies and toxic substances were observed to be accessible to residents in cabinet under kitchen sink and bathroom #1 deficiency cited. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Sharps are locked and placed in cabinet in kitchen. There are no firearms or weapons stored at the facility. The two bathrooms contain a working toilet, basin and water faucet, shower with grab bar, shower chair, and bathmat. The hot water temperature in the bathrooms were measured between in the required range of 105-120 degrees F. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. The garage is clean and has extra supplies. One (1) out of four (4) Staff files were reviewed and included Criminal clearance record, CPR, and health screening with TB. Two staff did not have current CPR. Five (5) out of Six (6) residents files were reviewed and included physicians report, TB clearance. Two residents were missing Physicians reports and two were missing hospice care plan. Fire/earthquake drill was conducted in October of 2024 Infectious control plan was reviewed. The medications are centrally stored and locked in a cabinet in kitchen The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all residents and one (1) out of six (6) are not given out properly. During Visit LPA observed medication in refrigerator not in locked box. Facility did not have current liability insurance. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Julio Navallo.the state’s words, verbatim · CDSS document, Nov 2, 2024

Type of visit: Required - 1 Year

On 12/05/23 at 8:50 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Cerritos Villa I. Upon arrival LPA was greeted by Direct Support Professional (DSP) Cristina Riego who contacted the RN consultant Alda Farren. This home is licensed to serve elderly residents aged 60 and above. All residents can be non-ambulatory. Facility approved to accept or retain one resident on hospice. Facility is 87724 compliant. There is no staff room. Therefore, facility will provide 24-hour awake staff. No staff room, therefore, facility will provide 24-hour awake staff. There were (3) residents in care during the time of this visit, the other (1) resident were at the day program and (1) resident was hospitalized. The last emergency disaster/fire drill was conducted on 11/18/23. The Administrator Certificate expired on 8/31/2023 #6059713740. The facility was unable to provide proof of a valid Administrator Certificate. LPA Baptiste also reviewed the pending and active administrator certificates online and was not able to find proof of valid Administration certificate. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (2) staff files, (5) resident files, medications, and medication administration records for (4). This home contains 4 bedrooms, 2 bathrooms, living room, office, kitchen, dining room and an attached garage. LPA toured the physical plant with the RN consultant. and observed all (4) resident bedrooms, contained required furniture, lamps, dresser, chair, and closet space. The two bathrooms contain a working toilet, basin and water faucet, walk in shower with grab bar, shower chair, and bathmat. The temperature measured at 121.8*F-127.2*F respectively which does not meet title 22 guidelines. This poses a potential safety hazard to the clients in care. The smoke detectors were battery operated and individually tested and observed to be working properly. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were (2) fire extinguishers located in hallway and dining room fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans. The knives were unsecured in kitchen cabinet and backyard. The cleaning agents and toxins was unsecured in the bathroom, kitchen, and backyard. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home. LPA reviewed medications and observed some medications was marked as given before time or medications was missing for the wrong time frame. During file review LPA confirmed Staff S1 and S2 was not associated to the facility. (Report continued on LIC809C.) The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for client use. The garage contained a working washer and dryer, with cabinetry that contained emergency supply kits, bottled water, toiletries, personal care supplies, and toxins and cleaning agents stored locked and inaccessible to the clients. The office contained notifications and postings: California Labor Laws, Emergency Disaster Plan, personal rights, facility license, business license, medical emergency information, let-us-know licensing contact information, consumer grievance, support services, community resources and client hygiene schedule. The following Deficiencies were cited on the LIC809D, and civil penalties was assessed. Exit interview conducted with Alda Farren, RN consultant, a copy of this report was provided, and Appeal rights given.the state’s words, verbatim · CDSS document, Dec 5, 2023