Emerald Home Care of Ventura

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. Upon arrival, LPA was greeted by staff. Administrator Jovilito Gagarin was contacted and arrived shortly after the visit began. Entrance interview conducted. The LPA along with Administrator and staff toured the facility to ensure there are no health and safety hazards and the facility is in compliance with regulation. The following was observed: Fire extinguisher was observed to be fully charged and last serviced 06/23/2026. Hardwired combination smoke and carbon monoxide detectors were tested and were functional at that time. KITCHEN/FOOD SERVICE AREA: The facility has a sufficient supply of perishable and non-perishable foods, emergency food and water. Knives and sharp items were stored in a locked drawer. Cleaning supplies and disinfectants were stored underneath the locked kitchen sink and in the locked cabinet above the washer. The facility has a sufficient supply of plates, cups, and utensils. RESIDENT BEDROOMS/BATHROOMS: The facility consists of 6 (six) bedrooms; 1 (one) is designated for staff use and 5 (five) are resident rooms. All 5 (five) bedrooms are furnished for resident use, containing all required furnishings and a sufficient supply of linens. The staff room remains locked. There are 2 (two) restrooms in the facility. 1 (one) is a shared resident bathroom and the other is for private resident bathroom in room #4. Both restrooms were observed to be clean and sanitary with grab bars and slip-resistant surfaces. Bathrooms had sufficient supply of hand soap, paper towels, and hygiene products for resident use. Hot water was tested in the common restroom at 118.4 F and the restroom in room #4 measured at 112.6 F within the required range. Report continued on LIC 809-C COMMON AREAS: The sitting area/television room, and dining area are furnished appropriately. The LPA observed the required postings in the entry way. Auditory devices on all exits were operational. Common area was maintained at a comfortable temperature during the visit. The facility has a laundry closet located off the hallway leading to the garage, which contains an operational washing machine and dryer. Activity supplies were observed, including games, and a piano. OUTDOOR SPACE: The back yard area is enclosed, with one gate that was observed to be self-closing and latching. Although the latch has a built-in lock, the LPA reminded the Administrator that the gate cannot be locked due to fire safety and fire clearance. The backyard contains a shaded seating area and appropriate outdoor furnishings. There are no bodies of water on the premises. The backyard contains access to a locked garage. LPA observed the garage to contain extra cleaning supplies, storage, and paper goods. RECORD REVIEW: The LPA reviewed 5 (five) resident files for items including but not limited to: physician’s report, Admission Agreement, personal rights, and needs and service appraisal. All resident records reviewed contained all required documents. The LPA reviewed 5 (five) staff files for documents including but not limited to: health screening, TB test results, and trainings. 2 of 5 (five) staff files reviewed had health screening and TB test result that were more than a year old. Best practices were discussed. MEDICATIONS: Medications were observed to be locked and stored in compliance with regulation. The LPA reviewed medications for 2 (two) residents. During Resident 1's (R1's) audit the LPA observed that R1 was prescribed calcium carbonate-Vit D3 600 mg-10mcg but their medication box had oyster shell calcium with vitamin d3 500mg and Calcium citrate (630mg) with Vitamin D3 per serving, was prescribed Vitamin B12 and Vitamin B9 but had a bottle of B Complex #1, and had a bottle of MiraLax but no current order for it. Staff indicated that the resident arrived with the MiraLax from their previous location alongside the order summary report, however has not taken it. Staff were advised to contact R1's physician for an updated medication list. During R2's audit the LPA observed a bubble pack of Losartan, quantity of 15 (30 half tablets) that started on 7/17/26 and had the medication count of 14 tablets left. INTERVIEWS: During today’s visit, the LPA interviewed 3 (three) residents and 1 (one) staff. No concerns were voiced at this time Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 3, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Case Management – Incident visit at 02:07PM. The LPA met with facility staff. Administrator was contacted and arrived at 02:25PM. Entrance interview conducted. The Department received a self-reported incident and death report regarding Resident #1 (R1) on 09/15/2025. LPA requested documents for R1 be sent via email, which were received on 10/27/2025. Incident report indicates that on 10/23/2025, R1 was experiencing shortness of breath, 9-1-1 was contacted and R1 was subsequently taken to the hospital. Death report indicates R1 passed away on 10/25/2025 at the hospital, however no additional information was provided. During today’s visit, LPA conducted a brief physical plant tour to ensure there are no immediate health and safety concerns, conducted interviews with Administrator and staff and LPA obtained copies of pertinent documents relevant to the incident. Record review revealed R1 was admitted to the facility on 09/26/2025 after being discharged from a Skilled Nursing Facility. Interview revealed R1 was admitted to home health services and a nurse visited the facility twice a week to care for R1's health needs. Interview further revealed that on 10/23/2025, R1 had been coughing and had excess phlegm since the morning and the nurse visited that afternoon. Later that evening around 09:00PM, the resident experienced shortness of breath and at approximately 11:30PM, R1 was taken by ambulance to the hospital. The LPA informed Administrator that either LPA or Investigations Branch (IB) Investigator will follow up related to R1's death. No citations issued. Exit interview conducted. A copy of the report was provided via email.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. Upon arrival, LPA was greeted by staff. Administrator was contacted and arrived shortly after the visit began. Entrance interview conducted. Beginning at 10:25AM, the LPA along with Administrator toured, the facility to ensure there are no health and safety hazards and the facility is in compliance with regulation. The following was observed: Fire extinguisher was observed to be fully charged and last serviced 08/22/2025. Hardwired combination smoke and carbon monoxide detectors were tested at 12:29PM and were functional at that time. OUTDOOR SPACE: The back yard area is enclosed, with one gate that was observed to be self-closing and latching. Although the latch has a built-in lock, the LPA reminded the Administrator that the gate cannot be locked due to fire safety and fire clearance. The backyard contains a shaded seating area and appropriate outdoor furnishings. There are no bodies of water on the premises. The backyard contains access to a locked garage. LPA observed the garage to contain extra cleaning supplies, storage, and paper goods. RESIDENT BEDROOMS/BATHROOMS: The facility consists of 6 (six) bedrooms; 1 (one) is designated for staff use and 5 (five) are resident rooms. All 5 (five) bedrooms are furnished for resident use, containing all required furnishings and a sufficient supply of linens. Resident #1 (R1) was observed to have full bed rails on their bed, however, R1 is not on hospice and does not have an exception on file for use of full bed rails. The staff room remains locked. There are 2 (two) restrooms in the facility. 1 (one) is a shared resident bathroom and the other is for private resident use. Both restrooms were observed to be clean and Report continued on LIC 809-C sanitary with grab bars and slip-resistant surfaces. Bathrooms had sufficient supply of hand soap, paper towels, and hygiene products for resident use. Hot water was tested in the common restroom and measured within the required range. COMMON AREAS: The sitting area/television room, and dining area are furnished appropriately. Paint, windows, window coverings, and floors are in good repair. The LPA observed the required postings in the entry way. Auditory devices on all exits were operational. Common area was maintained at a comfortable temperature during the visit. The facility has a laundry closet located off the hallway leading to the garage, which contains an operational washing machine and dryer. Activity supplies were observed, including games, and a piano. Cameras were observed in the common areas. Administrator forwarded LPA an email dated 07/30/2025 regarding the use of cameras. LPA will review the request and follow up with Administrator as appropriate. KITCHEN/FOOD SERVICE AREA: The facility has a sufficient supply of perishable and non-perishable foods, emergency food and water. Knives and sharp items were stored in a locked cabinet under the sink. Cleaning supplies and disinfectants were stored underneath the locked kitchen sink and in the locked cabinet above the washer. The facility has a sufficient supply of plates, cups, and utensils. RECORD REVIEW: Beginning at 10:48AM, the LPA reviewed 5 (five) resident files for items including but not limited to: physician’s report, Admission Agreement, personal rights, and needs and service appraisal. All resident records reviewed contained all required documents. Beginning at 11:32AM, the LPA reviewed 4 (four) staff files for documents including but not limited to: health screening, TB test results, and trainings. 3 (three) of 4 (four) staff files reviewed did contain documentation of training, however, all were recently hired and did not contain proof of 40 hours initial training, however all transferred from other facilities where trainings were completed. Additionally, 2 (two) direct care staff did not have current first aid training. LPA provided additional information to the Administrator related to trainings. MEDICATIONS: Medications were observed to be locked and stored in compliance with regulation. Beginning at 12:32PM, LPA reviewed medications for 2 (two) residents. During medication review, LPA noted that both residents have been prescribed PRN (as needed) medications, but do not have a PRN authorization form on file indicating whether the resident can determine their need for a PRN medication. Additional information related to medication administration and best practices were discussed with the Report Continued on LIC 809-C Administrator. LPA provided the Administrator with the Technical Support Program (TSP) Medication Guide for reference. EMERGENCY DISASTER PLAN/INFECTION CONTROL PLAN: During today’s visit, LPA reviewed both the facility’s emergency disaster plan and infection control plan. The facility’s procedures as it relates to infection control are adequate. Both documents have been reviewed and updated annually as required. The facility’s last documented emergency disaster drill was a fire drill conducted on 07/21/2025. INTERVIEWS: During today’s visit, the LPA interviewed 3 (three) staff. Residents were unable to be interviewed at this time. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 25, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rankin conducted an announced Pre-Licensing inspection at the facility today and met with Licensee Representative/Applicant Jovilito Gagarin and Caregiver Merlita Peacock. The facility obtained a fire clearance on 05/16/24 for a total of 6 (six) non-ambulatory residence. During today's visit, LPA completed Component III with the Applicant Representative. The facility is a single-story home in the Ventura area, which consists of 6 (six) bedrooms and 2 (two) bathrooms. Five of the bedrooms are resident rooms, 1 (one) is a staff/office room approved on the fire clearance. Beginning at 10:58AM, the LPA, along with Applicant Representative, conducted a physical plant tour to ensure there are no health and safety hazards and the facility is in compliance with regulation. The following was observed: KITCHEN/FOOD SERVICE AREA: The facility has a sufficient supply of non-perishable foods, emergency food and water. Knives and sharp items will be stored in a locked cabinet under the sink. Cleaning supplies and disinfectants will be stored underneath the locked kitchen sink and in the locked cabinet above the washer. The facility has a sufficient supply of plates, cups, and utensils. RESIDENT BEDROOMS/BATHROOMS: The resident bedrooms were observed. All 5 (five) bedrooms are furnished for resident use. The resident bathrooms were observed to be clean and sanitary with grab bars and non-skid mats. Report continued on LIC 809-C Hot water was measured in the kitchen and measured within the required range. Bathrooms had sufficient supply of hand soap and paper towels for resident use. COMMON AREAS: The sitting area/television room, and dining area are furnished appropriately. Paint, windows, window coverings, and floors are in good repair. The LPA observed the required postings in the entry way. Auditory devices on all exits were operational. Common areas were maintained at 72 degrees during the visit. Combination smoke alarms and carbon monoxide detectors were tested at 11:27AM and were operational at this time. Fire extinguisher was observed to be fully charged and Applicant stated they were recently purchased. LPA advised Applicant to maintain the receipt from purchase or proof of annual inspection. The facility has a laundry closet located off the hallway leading to the garage, which contains an operational washing machine and dryer. Medications will be locked and centrally stored in a cabinet in the kitchen/dining area. First aid supplies were reviewed and observed to be in compliance. Activity supplies were observed, including games, and a piano. Internet services will be available for all residence use. OUTDOOR SPACE: The back yard area is enclosed. Per fire clearance only one side of the house has a gate which was observed to not currently have self-closing or self-latching abilities, a plan to update the hinges for this specialized gate was discussed and will be implemented. The backyard contains a shaded seating area and appropriate outdoor furnishings. There are no bodies of water on the premises. The backyard contains access to a locked garage. LPA observed the garage to contain extra cleaning supplies, storage, and paper goods. LPA observed cameras located in the front yard area, these are from the prior home owners and will be removed. If replaced the Licensee Representative indicated they will submit an amended Plan of Operation as well as address them in the facility Admission Agreement, as advised by the LPA. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 8, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity:6 Census (if any clients in care): N/A COMP II Participants: Jovalito Gagarin, Licensee; Jesusa Carbajal, Licensee; and Merlita Vetter, Licensee Interview Method: Telephone interview On [06/24/2024], applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 24, 2024