Country Club Villa

Type of visit: Required - 1 Year

On 07/20/2026, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator Assistant, Wilhelmina Iglesias. The purpose of the visit was explained, and the LPA was allowed entry to the facility. This facility is licensed to serve 6 non-ambulatory adults ages 60 and above. The facility has an approved hospice waiver for 4 residents. A total of 5 residents is currently residing in this facility. The Annual Licensing Fees are current. Facility Layout: The facility is a one-story structure with 5 bedrooms, 4 bathrooms, living room, kitchen and inside and outside patio. Outside Grounds: were toured no bodies of water were observed, walkways around the home were clear of hazards, and there are no security bars or weapons on the premises. Kitchen Area/Facility Food: The facility has supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. There is fire extinguisher in the kitchen area, and it was last serviced on 01/13/2026. Resident Bedrooms: 5 out of 5 resident bedrooms were toured. There is adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Bathrooms: Toilets, showers, and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. Medications: were inaccessible to residents in care. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Technical Assistance was provided regarding de-cluttering garage and the facility. 5 staff records were reviewed, 5 out of 5 staff records had required documentation. 5 resident records were reviewed and, 5 out of 5 resident records had required documentation. No deficiencies are being cited based observation and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and a copy of this report was left with the Administrator Assistant, Wilhelmina Iglesias.the state’s words, verbatim · CDSS document, Jul 20, 2026

Type of visit: Required - 1 Year

On July 16, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA was met by Wilma Iglesias Assistant Administrator and the purpose of today's visit was explained. The facility is licensed to serve 6 elderly residents, all of which (6) may be non-ambulatory with a hospice waiver approved for two (2) aged 60+ years. The facility currently has 2 resident on hospice. Physical Plant/Structure: The facility is a 1-story structure with 5 bedrooms, 4 bathrooms, living room, kitchen and inside and outside patio. Bedrooms: LPA inspected all 5 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Page 1 of 3 Bathrooms: Toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature, and it measured 106.6 degrees Fahrenheit. Common Rooms: All common areas are clean and free of obstructions. There is adequate seating for the residents in care. Each common area is equipped with furniture that is in good repair. Required Postings: LPA observed all required documents posted throughout the facility. The facility has a working landline telephone. Kitchen LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. Sharps were locked away and inaccessible to the residents. Safety LPA observed 2 fully charged fire extinguishers bought on 5/9/25. The last emergency drill was conducted on 5/16/25. First aid kid had all the required continents. File Review: LPA reviewed 4 resident files and found that ( 4 ) out of ( 4 ) had the required documents. LPA reviewed 4 staff files and found that ( 4 ) out ( 4 ) had the required documents, training, and certifications. Page 2 of 3 Medications LPA observed all centrally stored medications which were secured and locked. All medications were observed in their original packaging. LPA review 2 residents medication and MAR and found no discrepancies. Infection Control LPA observed required infection control signs posted throughout the facility. LPA observed a sanitizing stations in entryway of facility. LPA observed an ample supply of PPE supplies. Facility maintains General Liability Insurance which expires 6/30/26 No deficiencies cited during today's visit. Exit interview conducted, copy of report provided to Assistant Administrator Wilma Iglesias Page 3 of 3.the state’s words, verbatim · CDSS document, Jul 16, 2025

Type of visit: Required - 1 Year

On 07/20/24 at 9:26 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Assistant Administrator Wilma Iglesias. Administrator Max Iglesias joined us shortly afterwards. The facility is licensed to serve six (6) elderly residents, all of which (6) may be non-ambulatory with a hospice waiver approved for two (2) aged 60+ years. The facility currently has one resident on hospice. The facility is a 1-story structure with 5 bedrooms, 4 bathrooms, living room, kitchen and inside and outside patio. The Assistant Administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, and hot water temperature properly measured at 109.5F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Continue to LIC809-C. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced March 20, 2024 was observed in the kitchen area. Administrator tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional. 5 staff records were reviewed, 5 out of 5 staff records had current first aid certificates and required criminal record clearances or criminal record exemptions. 5 resident records were reviewed and, 5 out of 5 resident records had medical assessments. Two residents’ medication was reviewed. No deficiencies are being cited. An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with Assistant Administrator Wilma Iglesias.the state’s words, verbatim · CDSS document, Jul 20, 2024

The state marks this report as 12 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.