Graceful Living at Village One

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 03/19/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility live-in caregivers, Teresa Lopez and Shelly Schwartz, who were briefly interviewed at this time. This LPA requested that they go ahead and contact the facility designated Administrator to inform them that CCL was present at this time. The facility designated Administrator, Voica Matis, arrived shortly thereafter to this facility and was briefly interviewed at this time. Current census was 5 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (2) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (4) residents diagnosed with dementia at this time. It was learned that there were (4) residents receiving services through home health at this time. It was learned that this facility does have a bedridden fire clearance to be able to accept or retain up to (2) residents deemed to be bedridden at any given time. There was (1) resident deemed to be bedridden at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Garage area was toured which had been converted into staff quarters at this time. Laundry area, located next to the garage area, was toured and observed to be locked at this time. A review of the bleach, detergent, and all other cleaning supplies was conducted to make sure that they were locked and made inaccessible to the residents at this time. Administrator certificate # 7025797740 for Rainileo Clavano was observed to have an expiration date of 06/25/2027 and in compliance at this time. Medication cabinet, located in the facility kitchen cabinet, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher located hanging on the wall adjacent to the kitchen was observed to have been annually inspected by the local fire extinguisher company, Touch Down Fire Equipment, with the inspection date of 02/05/2026 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees at all times. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (4) facility personnel records was conducted and noted on the following LIC 859. A review of (5) facility resident records was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Mar 19, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct one year required inspection. LPA Lund met with Administrator Rainileo Clavano and explained the purpose of the visit. Census: 4 LPA Lund & Administrator Rainileo Clavano toured/inspected the facility and observed them to be well maintained. All paths were free of obstruction. There is outdoor furniture and shaded areas. Thermostat was set at 75 degrees which falls in the required range of 68-85 degrees.. All furniture and appliances were observed to be in good repair. The facility was sanitary and free of odor. The bedrooms contained all required furniture. The bathrooms were equipped with grab bars and had non-slip flooring in the bath/shower. There is an adequate supply of linens and grooming supplies. The water temperature in the common bathroom was measured at 109 degrees which falls within the required range of 105-120 degrees Fahrenheit. The first aid kit was observed to be complete. The carbon monoxide detector and smoke detector were tested and found to be in good working order. The fire extinguisher was last serviced in February of 2025 and is in compliance. All toxins and medications were observed to be locked and inaccessible to clients in care. LPA Lund inspected the kitchen. There was two- day supply of perishable food and a 7- day supply of non-perishable food. LPA Lund reviewed 2 staff files and determined them to be complete. LPA Lund reviewed 2 resident files and determined them to be complete. The medications were observed to be locked and inaccessible to residents in care. No deficiency were cited during today visit. Exit interview done and report left.the state’s words, verbatim · CDSS document, Mar 26, 2025

Type of visit: Required - 1 Year

On 3/1/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual inspection. LPA Jensen met with Licensee Voica Matis and explained the purpose of the visit. LPA Jensen toured the grounds and observed them to be well maintained. All paths were free of obstruction. There is outdoor furniture and shaded areas. All window screens were observed to be in good repair. LPA Jensen toured the physical plant. The thermostat was set at 74 degrees which falls within the required range of 68-85 degrees Fahrenheit. There was adequate lighting and furnishings throughout. All furniture and appliances were observed to be in good repair. The facility was sanitary and free of odor. The bedrooms contained all required furniture. The bathrooms were equipped with grab bars and had non-slip flooring in the bath/shower. There is an adequate supply of linens and grooming supplies. The water temperature in the common bathroom was measured at 108 degrees which falls within the required range of 105-120 degrees Fahrenheit. There are night lights in the hallways. LPA Jensen reviewed the disaster plan and determined it to be in compliance. The facility maintains an emergency supply of water and lighting. The first aid kit was observed to be complete. The carbon monoxide detector and smoke detector were tested and found to be in good working order. The fire extinguisher was last serviced in February of 2024 and is in compliance. All toxins and medications were observed to be locked and inaccessible to clients in care. LPA Jensen toured the kitchen. There was in excess of a two day supply of perishable food and a 7 day supply of non-perishable food. There was no expired food product observed. LPA Jensen conducted this visit while lunch was being served which consisted of a BLT sandwich, soup and fresh baked cookies. LPA Jensen reviewed 4 staff files and determined them to be complete. LPA Jensen reviewed 3 resident files and determined them to be complete. The facility sketch accurately reflects the facility layout. The census is consistent with the fire clearance. All required postings were observed to be displayed in easily viewable locations. Liability insurance was reviewed and is compliant. LPA Jensen conducted a random medication audit and determined that medication for R1 was not accurately logged in the Centrally Stored Medication and Destruction Record. The medications were observed to be locked and inaccessible to residents in care. LPA Jensen interviewed two residents that indicated they were satisfied with all aspects of care. The facility has hired a new Administrator. All required paperwork has been submitted for the change in Administrator. The Department is pending notification from the Administrator Certification Unit in order to process the change in the Licensing System. A deficiency was cited pursuant to the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties.the state’s words, verbatim · CDSS document, Mar 1, 2024