Elegant Care Villa

Type of visit: Required - 1 Year

On July 27, 2026, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrators Neome Golfo and Divina Alipio were available to assist with the facility inspection. The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for one (1). Currently, there are three clients and zero (0) Hospice residents present during today’s visit. This is a single story with an attached garage facility. The facility has three bedrooms, and three bathrooms. LPA conducted a tour of the physical plant accompanied by caregiver, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 109.5 degrees F. A comfortable temperature of 77 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for sharps and toxins were secured and not made available to clients. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility had one fire extinguisher that was fully charged. A review of the Medication Administration Record (MAR) was conducted, and LPA observed the records are in compliance. CONTINUED ON 809C During the visit, LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has Personal Protective Equipment (PPE). All mandated inspection control posters were posted. Facility has a supply of emergency food and water. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on June 29, 2026. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. A review of three clients (C1-C3) service files and three staff (S1-S3) personnel files revealed to be complete. The facility has the current administrator's certification on file for Myrna Alipio # 7035700740 - Expiration 7/14/2027 No deficiencies during this inspection visit. An exit interview was conducted with Divina Alipio, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 27, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 07/17/2025. LPA knocked on door and no answer. LPA called Administrator and Davina Alipio arrived at 1:15 AM. *Deficiency cited under H & S 1569.625(b)(2) pertaining to Staff Training has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. Licensee addressed item issued on advisory dated 07/17/2025. Licensee has been advised to maintain compliance in all items previously cited. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to conduct the annual required visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory clients with 1 hospice waiver. The facility currently has 3 clients with none on hospice. Divina Alipio has an Administrator Certificate expiring on 06/19/2026. Administrators David and Divina Alipio arrived during the visit. The facility appears clean and sanitary. LPA Lyman along with care staff Danny Garcia toured the facility at 8:23 AM. LPA toured the physical plant, checked food service, and reviewed facility documentation. The home consists of three client bedrooms, one shared hall restroom, client restroom, staff office, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, and grab bars were secure. Water temperature measured between 110.4 and 112.6 degrees F in facility restrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including thermometer, tweezers and scissors as well as a first aid manual. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguisher is fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating for clients. Exit gate is unlocked, self latching and operational. LPA observed ample emergency food and water supply as well as emergency packs for clients. LPA reviewed the emergency disaster plan as well as infection control plan during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 06/02/2025 and drills are conducted quarterly. CONTINUED ON LIC 809C DATED 07/17/2025 Facility provides activities in the form of games, exercise and outings in the community. At 9:00 AM, LPA reviewed two client files and three staff files. Client files contained required documents including admission agreements, physician reports and client appraisals. Staff files reviewed contained required documentation of health screens/ TB and criminal record clearance. Staff files reviewed contained CPR certification but not required annual training. LPA reviewed medication storage and administration. Facility uses a medication administration record. Medications are stored in a locked cabinet and are being administered per physician order. LPA reviewed P & I money with staff. Ledgers match cash on hand. Based on the observations made during today’s visit, deficiency is being cited per California Code of Regulations Title 22 Division 6. Exit interview conducted and a copy of this report as well as appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 17, 2025

Type of visit: Case Management - Other

On February 5th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of a case management visit. Upon arrival LPA Vanegas was greeted and granted entry by Direct Support Staff (DSP) Danilo Garcia and explained the nature of the visit. LPA Vanegas explained that this visit was to notify licensee of generated report for incorrect facility and that the report had been amended. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 5, 2025

Type of visit: Annual/Random

On December 30th, 2024 Licensing Program Analyst (LPA) William Vanegas generated this report in error. This report was drafted for a different facility the report generated in error has been amended and a copy of the report was provided to the correct facility. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 30, 2024

Type of visit: Required - 1 Year

Licensing program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to conduct the annual required visit. LPA was greeted and granted entry into the facility by and explained the reason for the visit. Facility is licensed for 6 non-ambulatory clients with hospice waiver for 1. The facility currently has 3 clients with no clients on hospice. Michael Rillera has an Administrator Certificate expiring on 01/30/2026. Administrator Armando Flores arrived during the visit. The facility appears clean and sanitary. LPA Lyman along with Licensee Michael Rillera toured the facility at 7:45 AM. LPA toured the physical plant, checked food service, and reviewed facility documentation. The home consists of four client bedrooms, two shared hall bathrooms, client restroom, one staff room, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, and shower was free of mold/mildew. Water temperature measured between 109.2 and 116.1 degrees F in facility bathrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including thermometer and scissors as well as a first aid manual. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. smoke detectors and carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for clients. Exit gate is unlocked and operational. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan as well as infection control plan during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 04/09/2024 and drills are conducted quarterly. Facility provides activities in the form of games, exercise and outings in the community. At 9:00 AM, LPA reviewed three client files and two staff files. Client files contained required documents including admission agreements, physician reports and client appraisals. Staff files reviewed contained required documentation of training and criminal record clearance.the state’s words, verbatim · CDSS document, Jul 5, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to conduct the annual required visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory clients with 1 hospice waiver. The facility currently has 3 clients with none on hospice. Myrna Alipio has an Administrator Certificate expiring on 07/14/2025. Administrator David Alipio arrived during the visit. The facility appears clean and sanitary. LPA Lyman along with Administrator David Alipio toured the facility at 7:58 AM. LPA toured the physical plant, checked food service, and reviewed facility documentation. The home consists of three client bedrooms, one shared hall bathroom, client restroom, staff office, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, and shower was free of mold/mildew. Water temperature measured between 113.7 and 114.2 degrees F in facility bathrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including thermometer, tweezers and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguishers is fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating for clients. Exit gate is unlocked, self latching and operational. LPA observed ample emergency food and water supply as well as emergency packs for clients. LPA reviewed the emergency disaster plan as well as infection control plan during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 06/12/2024 and drills are conducted quarterly. Facility provides activities in the form of games, exercise and outings in the community. At 9:00 AM, LPA reviewed three client files and four staff files. Client files contained required documents including admission agreements, physician reports and client appraisals. CONTINUED ON LIC 809C DATED 07/05/2024 Staff files reviewed contained required documentation of training, health screens/ TB and criminal record clearance. Staff files reviewed contained CPR certification. At 9:45 AM, LPA reviewed medication storage and administration. Facility uses a medication administration record. Medications are stored in a locked cabinet and are being administered per physician order. LPA reviewed P & I money with staff. Ledgers match cash on hand. Based on the observations made during today’s visit, NO deficiencies are being cited. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Jul 5, 2024

Allegation investigated: Staff took an undressed photo of resident Staff threw a trash can at resident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, the Department interviewed clients, witnesses and staff as well as reviewed and obtained pertinent documentation such as Individual Program Plans. Regarding the allegations that staff took an undressed photo of resident and staff threw a trash can at resident, the investigation revealed the following: On 11/27/2023, Day Program Staff observed discoloration on Resident 1’s (R1) knee. Resident stated that Staff 1 (S1) had thrown a trash can at their knee ten times as well as taken an undressed photo of the resident. Upon the Department’s interview with R1, R1 denied the allegations and then later changed the allegation to the trash can being thrown only one time. R1 denied any previous abuse from the staff and states the staff is a CONTINUED ON LIC 9099C DATED 1/29/2024 Unsubstantiated friend whom they like. R1 stated the incident was unwitnessed. The Department reviewed S1’s camera and found there were no pictures of the resident on the camera. S1 reported they never shower R1 without a female staff present. This was confirmed by the facility Administrator. S1 reported the bruise on the knee occurred during transfer in the shower and denied both allegations made. R1’s Regional Center Service Coordinator reported they have been working with R1 for twelve years and the resident denied all allegations during their interview. Interviews conducted confirm R1 has a long history of false allegations. Resident’s Individual Program Plan dated 03/16/2023 indicates a diagnosis of Psychiatric Disorder as well as a history of making false statements. Two out of two additional residents at the facility interviewed denied any physical or sexual abuse occurring at the facility and both verbalized feeling safe at the facility. Based on records reviewed and interviews conducted, the Department is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted, and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Jan 29, 2024 · control 22-AS-20231201154934

Type of visit: Required - 1 Year

an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff and LPA explained the nature of the visit. Divinajoy Alipio, Administrator arrived shortly after and met with LPA. There are three residents at the facility and there are no residents receiving hospice services currently. LPA was informed one resident was out in the facility. There were two residents at the time of the visit. LPA accompanied with staff began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in freezer located in garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the living room. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the bathroom and LPA measured the hot water temperature which measured 105.1 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in storage cabinet in garage. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment. LPA observed a fire extinguisher with service date of July 17, 2023, in dining room. Fire drills are conducted every three months. LPA began review of records. LPA reviewed three resident records. All the required documentation was Continued on LIC809-C present and current in the residents’ files reviewed. LPA reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Oct 17, 2023