Cottages at the Colony of Valley Glen #4

Type of visit: Collateral

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced Collateral visit. The LPA arrived at 2:02PM and met with Administrator Anna Lee. Entrance interview conducted. Between 2:22PM and 2:35PM, the LPA and Administrator conducted a physical plant tour and interviewed one (1) resident. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 11:24AM. The LPA met with the Administrator Anna Lee and informed them of the reason for the visit. Entrance interview conducted. Beginning at 11:39AM, the LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: OUTDOOR AREA: The rear yard had a shaded patio area equipped with furniture in good condition for resident and visitor use. Exits and passageways were free of obstructions. There was one (1) emergency side exit with a self-latching gate. The facility had a secured garage that contained emergency food and water, laundry machines in good condition, extra food, and general storage. COMMON AREAS: At the time of the visit, two (2) living rooms and dining room furniture were observed to be in good condition. A fireplace was observed in the living room that was screened and inoperable. Required postings were observed in the entryway. Facility hallway closets included locked cleaning supplies and extra linens. The facility maintained a comfortable temperature throughout the visit and nightlights were observed throughout the hallways. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There were six (6) total bedrooms, each private. Bedrooms #5 and #6 had a direct exit to the outside and the facility approved for six (6) bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There were four (4) total restrooms in the facility: three (3) private and one (1) shared. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 114.4 degrees F and 117.3 degrees F which is within the required range per regulation. KITCHEN: The LPA observed knives stored inaccessible in a locked drawer. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food. Food in the refrigerator and freezers were observed to be properly stored with labels and dates. The Kitchen had a locked medication closet and secured staff room. RECORDS: Record review began at 12:09PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Fire extinguishers were observed and last serviced on 10/07/2025. Emergency disaster drills are conducted quarterly, with the last documented drill on 12/01/2025. Smoke and carbon monoxide detectors and fire doors were tested at 12:41PM and were operational. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 12:43PM. Medications were centrally stored and kept inaccessible in a medication closet in the kitchen. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 23, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct an unannounced Case Management - Annual Continuation at the facility today continuing the inspection that began on 01/24/2025. LPA Mosley entered the facility at 9:30a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator arrived shortly thereafter. LPA met with the Administrator, Anna Lee and explained the reason for the visit. The LPA briefly toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. RECORDS: Resident Records were reviewed beginning at 10:02 a.m. and personnel records at 11:00 a.m. Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Five (5) personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INTERVIEWS: Two (2) staff and one (1) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 25, 2025

Allegation investigated: Staff left residents unsupervised during the night resulting in a resident being taken to the hospital

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to the above facility. On today's visit at 9:45 a.m., LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator, Anna Bernice D. Lee arrived shortly after and the reason for the visit was explained. Entrance interview. On 01/02/2025 The Department received a complaint regarding the following allegation, Staff left residents unsupervised during the night resulting in a resident being taken to the hospital. During the initial visit on 01/03/2025, LPA conducted a physical plant tour to ensure there were no immediate health and safety concerns, conducted in-person interviews with two (2) residents, four (4) staff including the Administrator. LPA also conducted a file review along with obtained copies of pertinent documents relevant to the investigation. REPORT CONTINUED ON LIC 9099-C..... Unsubstantiated REPORT CONTINUED FROM LIC 9099.... During today’s visit, LPA Mosley conducted a physical plant tour at 9:55 a.m. to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations. On the allegation Staff left residents unsupervised during the night resulting in a resident being taken to the hospital it is the concern of the Reporting Party (RP) that the facility had locked residents inside the facility with no staff supervision. To investigate this complaint, LPA conducted in person interviews with two (2) residents, and four (4) staff including the Administrator along with reviewed relevant documents pertaining to the investigation. Interviews with the residents revealed that they are unaware of any resident recently taken to the hospital at nighttime. Residents stated that they have never been locked in the facility at night without any staff supervision. Furthermore, residents state that there are always staff available as the facility has live in staff who are available 24/7. Residents noted that staff are regularly available with two (2) to three (3) staff scheduled daily and available to them. Staff interviews revealed that they have not had any resident recently taken to the hospital at nighttime. Staff state they have caregivers regularly scheduled and always have staff available to assist residents. Staff state that they have live in staff who are always available to residents who also conduct night checks. Staff deny ever leaving the residents alone at nighttime resulting in a resident being taken to the hospital. Interview with the Administrator revealed that they have not had any recent incident where a resident was taken to the hospital at nighttime. Administrator states that staff have never locked residents in the facility. Furthermore, staff are scheduled regularly covering all shifts as evidence of the staff schedule for the last month. Based on interviews and record review, the Department does not have sufficient evidence to determine that staff left residents unsupervised during the night resulting in a resident being taken to the hospital. Therefore, the above allegation is deemed UNSUBSTANTIATED at this time. No deficiencies cited. Exit interview conducted. Copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 24, 2025 · control 29-AS-20250102144153

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:45 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator, Anna Bernice D. Lee arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. GARAGE/BACKYARD: The garage is maintained locked at all times. LPA observed an adequate amount of emergency food and water. There is a laundry area, with a washer and dryer. Laundry detergent was observed in a locked cabinet. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. Adjacent to the garage there is an attached storage room that stores extra nonperishable food and (7) seven extra refrigerators and one (1) deep freezer. Refrigerators and food pantry were checked for proper labels and expiration dates. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private resident rooms and one (1) staff room. The staff room is kept locked at all times. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are four (4) restrooms. Three (3) are designated as private resident restrooms and one (1) is designated as shared/ common resident restroom. Resident restrooms were observed to be equipped with nonslip surface. Grab bars were observed in the bathrooms. The restrooms were sufficiently stocked with supplies and paper towels. The water temperature was measured all resident restrooms and ranged between 109.2-110.6 degrees Fahrenheit, all within the required range. Report Continued on LIC 809C... Report Continued from LIC 809... COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 11:04 a.m., hardwire combination of smoke / carbon monoxide detector and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 10/08/2024. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 12/02/2024 and are conducted quarterly with the next one scheduled in March. The facility had the second annual automatic sprinkler system checked and passed on 06/21/2024. Activities were observed in the common areas. The fireplace in the living room was adequately screened. Cleaning supplies and other chemicals are kept in a locked hallway closet adjacent to the entrance inaccessible to residents in care. KITCHEN: The LPA inspected the kitchen/food service area at 10:50 a.m. Knives and sharps were observed in a locked box that sits on the counter. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 110.1 degrees Fahrenheit at 10:52 a.m. MEDICATIONS: Medications review began at approximately 10:57 a.m. The medications are in a locked cabinet adjacent to the kitchen. Medications for four (4) residents were reviewed. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. Infection Control / Emergency disaster planning: During today’s visit the LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate. LPA obtained the following documents - Resident roster, LIC 500, and copy of the Limited Liability insurance. Due to time constraints the LPA will return to complete the annual at a later date. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 24, 2025

Allegation investigated: Facility staff inappropriately sexually touched a resident while in care.

Licensing Program Analyst (LPA) Emily Peraldi conducted a subsequent complaint visit to deliver final findings for the above allegation at 10:10 a.m. During today’s visit, the LPA met with Administrator, and explained the reason for the visit. On 12/12/2023, the Woodland Hills North Adult and Senior Care Regional Office received a complaint regarding a sexual abuse allegation. It was alleged that Staff #1 (S1) inappropriately touched Resident #1 (R1) while under the care of the facility. The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Peter Zertuche. Continued on LIC 9099-C. Unsubstantiated On 12/12/2023, from 12:45 p.m. to 2:30 p.m., Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to the facility. At 12:55 p.m., LPA Peraldi met with the Administrator and explained the reason for the visit. The LPA informed the Administrator that the complaint was assigned to the CCLD IB Investigator Peter Zertuche. From 12:54 p.m. to 1:30 p.m., the LPA conducted an interview with the Administrator, requested copies of pertinent documents, and along with the Administrator conducted a physical plant tour. The LPA determined further investigation was required prior to issuing a finding. Investigator Zertuche conducted interviews on 01/31/2024, at approximately 10:30 a.m., with Administrator, Anna Lee, on 01/31/2024, between 11:30 a.m. and 12:30 p.m., with three (3) residents. On 01/31/2024 at 5:30 p.m., Investigator Zertuche conducted a telephonic interview with R1’s son. On 02/06/2024, between 3:30 p.m. and 4:00 p.m., Investigator Zertuche conducted telephonic interview with hospital social worker and hospital nurse. On 02/14/2024, at 10:30 a.m., Investigator Zertuche conducted a telephonic interview with S1. On 02/14/2024, between 11:00 a.m. and 11:30 a.m., Investigator Zertuche conducted a telephonic interview three (3) facility staff. In addition, the investigator requested an incident report from the local police, however police took an injury report and closed their case with no further investigation after speaking to R1 and R1’s son. Investigator Zertuche also obtained and reviewed R1’s medical records. A review of R1’s Physician Report, dated 6/01/2023, revealed R1 had Dementia, Depression, Hypothyroidism, Insomnia, Seizure Disorder, and Chronic Pain. R1 was non-ambulatory and required assistance with all activities of daily living. R1’s admission agreement was signed and dated on 06/12/2023. During the Department’s investigation, the interview with R1’s son revealed that R1 had a history of making similar allegations in the past and a history of self-harm, where R1 would scratch R1’s genital area. R1’s son stated that the facility was a great place and did not think the abuse occurred. During the investigation, it was revealed that there were no witnesses to the abuse and per hospital staff, there was no Sexual Assault Response Team (SART) exam, and the cause of the labia tears were unknown. During staff interviews, they denied the allegations of S1 inappropriately touching R1. Interviews with multiple residents all denied that they experienced any type of inappropriate behavior from S1 and instead considered S1 to be a “great person.” Furthermore, interviews with hospital staff indicated that R1’s doctors could not identify the source of the vaginal scratches. None of the residents witnessed S1 behave inappropriately towards R1 or have witnessed any inappropriate behaviors from S1. Interviews with the Administrator and staff denied that any inappropriate behaviors form S1. Continued on LIC 9099-C. The Department’s investigation concluded that although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation “Sexual Abuse: S1 inappropriately touched R1 while under the care of the facility” is deemed Unsubstantiated at this time. Exit interview conducted. A copy of this report was issued.the state’s words, verbatim · CDSS document, Oct 29, 2024 · control 29-AS-20231211142332

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Emily Peraldi and Sandra Urena arrived at the facility unannounced to conduct a required annual visit. At 11:55 a.m., the LPAs met with the Administrators, Anna Bernice D Lee and Eleanor Jimenez explained the reason for the visit. At 11:56 a.m., the LPA along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. The facility is a single-story residential home with seven (7) bedrooms, six (6) for resident use and one (1) for staff use and four (4) bathrooms. OUTDOOR SPACE: At 11:56 a.m., the LPA observed the back patio. There are no bodies of water on the premises at the time of the visit. Laundry units, cleaning solutions, chemicals and hazardous items were inaccessible and locked away inside the locked garage. There is one (1) gate on the side of the house designated for an emergency exits. Passageways were free and clear from obstruction. KITCHEN: The LPAs observed the kitchen and dining area. Knives are stored in a locked safety box. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Food labels were observed for expiration dates. At 9:48 a.m., the kitchen faucet was measured and tested withing required range. Medications are located in a locked storage closet inside the kitchen. A first aid kit is located inside the kitchen. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. Continued on LIC-809-C. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Starting at 12:25 p.m., the hot water temperature for restrooms were tested and measured within the required range. Sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. COMMON AREAS: The LPAs observed common areas to be relatively clean and properly furnished. The LPAs observed the fire extinguisher to be fully charged and last serviced on 10/12/2023. At 12:21 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. Facility telephone was observed during the time of the visit. LPAs observed cameras in the common areas, and throughout the exterior perimeter of the facility. RECORD REVIEWS: Starting at 12:02 p.m., the LPAs conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. The LPAs requested a copy of valid liability insurance and Facility Emergency Plan and Infection Control Plan. The last emergency disaster drill took place on 03/01/2024. At approximately 12:36 p.m., the LPAs conducted a review of medication and medication documentation with staff for four (4) residents. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 10, 2024