Grannys Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct the required annual visit today. Upon arrival, the LPA was greeted by staff, who then contacted the Administrator telephonically and informed them of the visit. The Administrator, Victor Hernandez arrived at approximately 09:50am and the reason for the visit was explained. Entrance interview conducted. Beginning at 09:55am, the LPA along with the 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: Bedrooms: There are four (4) bedrooms for resident use. Two (2) bedrooms are designated as private / single bedrooms, and the other two (2) bedroom are designated as shared / double occupancy. Bedrooms were observed to be furnished appropriately and had sufficient lighting. Additional clean linens and towels were available for residents in care. LPA observed a staff bedroom on premises inaccessible to residents at the time of the visit. Restrooms: There are two (2) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with non-skid surfaces and grab bars. The bathrooms were sufficiently stocked with supplies and paper towels. Report Continued on LIC 809C... Report Continued from LIC 809... Starting at 09:57am, the hot water temperature was measured in resident bathrooms, and they measured between 105 and 120 degrees Fahrenheit, which is within the required range. Personal hygiene items were observed inaccessible to residents at the time of the visit. Common Areas: This includes the living room and dining room area. Furniture in the common areas was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature. The LPA observed a fire extinguisher to be fully charged with a charge date of 06/09/2026. Required postings were observed throughout the common space. The LPA observed a fireplace in the living room; adequately screened. Nightlights were observed throughout the facility. A sufficient supply of emergency food and water was observed at the time of the visit. No hazards/obstructions observed inside or out. Garage: The house has direct access to the garage. The garage was inaccessible to residents in care at the time of the visit. Washer and dryer were observed in the garage. Detergents and cleaning supplies were observed locked at the time of the visit. Outdoors: There is a shaded side patio with adequate furniture for resident use. Emergency passageway was observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms for emergency purposes. LPA observed a shed in the backyard for storage purposes. No bodies of water noted at the time of the visit. Kitchen: The LPA inspected the kitchen/food service area at approximately 10:12am. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Report Continued on LIC 809C... Report Continued from LIC 809C... Records: Record review began at approximately 10:35am. Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, preplacement appraisals, appraisals, and current needs and services plan. All files were in order. Six (6) personnel files were reviewed for, but not limited to: personnel records, health assessments with negative TB test results, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All personnel files were complete. The Administrator’s Certificate is valid until 11/15/2027. Emergency Disaster Planning: During today’s visit, the LPA reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; last disaster drill conducted on 05/21/2026. Medications: Medication review began at approximately 12:15pm. Medications are centrally stored and kept in a locked cabinet inside the office. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. LPA observed a complete first aid kit and manual. Medications appear to be administered as prescribed at the time of the visit. No citations issued at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jul 10, 2026

Type of visit: Case Management - Other

Licensing Program Analyst, Esther Cortez arrived on January 16, 2026 for an unannounced inspection to follow up on a substantiated allegation of a complaint investigation. The LPA met with Licensee Victor Hernandez and Co-administrator Celesty Hernandez. On August 15, 2023, the Department concluded a complaint investigation regarding the following allegations: Neglect/Lack of Care and Supervision – Facility failed to seek medical attention in a timely manner when facility resident sustained an injury (second degree burn) while in care at the facility; Neglect/Lack of Care and Supervision – Facility failed to provided supervision when facility resident sustained an injury (second degree burn) while at the facility; Facility staff did not report serious injury to resident’s responsible party; and Facility staff failed to treat resident with dignity by scolding and yelling at resident. The licensee was cited for Health and Safety Code §1569.312 Basic Services Requirements; California Code of Regulations (CCR) 87465(a)(1) Incidental Medical and Dental Care; 87211(a)(1)(B) Reporting Requirements; and 87468.1(a)(1) Personal Rights of Residents in All Facilities. At the time of the complaint visit on August 15, 2023, an immediate civil penalty of $500 was issued and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code § 1569.49(f). Report will continue on LIC809-C, 2nd page. The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section 15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility not providing proper care and supervision that resulted in a resident sustaining second degree burns to the torso and left arm. Today, January 16, 2026, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49(f) for a violation that the Department constitutes as serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on August 15, 2023, the amount of the civil penalty issued today will be $9,500. Exit interview conducted. A copy of the report issued. Appeal rights provided. Licensee Victor Hernandez and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Jan 16, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management - Annual Continuation at the facility today continuing the inspection that began on 06/06/2025. At 9:10 a.m., the LPA met with staff and explained the reason for the visit. Administrators Victor and Celesty Hernandez arrived shortly thereafter and were explained the reason for the visit. RECORD REVIEW: Starting at 09:20 a.m. the LPA conducted a file review. The LPA observed documentation of Infection Control Plan, Emergency Disaster plan and last disaster drill conducted on 06/01/2025. The LPA conducted file review for five (5) out of six (6) resident files and the following was observed: Three (3) out of five (5) residents had medical assessments that were over a year old, no other documentation of a routine annual visit was on file and all five (5) residents did not have Consent for Emergency Medical Treatment forms (LIC627C) on file, otherwise everything else was complete and current. The LPA conducted file review for five (5) out of six (6) staff files and the following was observed: S1 was missing 4 hours of postural support, restricted health conditions and hospice training, S2 and S3 were missing all of their annual training. Otherwise everything else was complete and current. MEDICATION REVIEW: Starting at 11:30 a.m. the LPA conducted a medication review for two (2) residents. Medications are stored in a locked office inaccessible to residents in care. Medications observed were labeled, stored, and properly documented at the at the time of the visit. The LPA observed a night-time Gabapentin pill for Resident #1 (R1) was missing based on the start date and quantity. Upon observation, Administrator Celesty stated they had already administered today by accident, which is not in accordance to the instructions on the medication label, indicating it as a bedtime medication. Report will continue on LIC809-C, 2nd page. INTERVIEWS: During today's visit, LPA interviewed 2 (two) staff and 2 (two) residents.. No immidiate concerns were voiced. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights providedthe state’s words, verbatim · CDSS document, Jul 15, 2025

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit at 03:15 PM. LPA met with facility staff and explained the reason for the visit. Staff reached out to Licensee/Administrator Victor Hernandez who arrived shortly after. Entrance interview conducted. The LPA, along with Licensee/Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher is fully charged and recently serviced on 06/04/2025. Smoke detectors and Carbon monoxide detector was tested and was functional at the time of the visit. Fire alarm is centrally located and can not be shut off without the fire department on site at the facility. KITCHEN: Kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of 7 (seven) days non-perishable and 2 (two) days perishable food. Knives were observed to be locked in a drawer. Cleaning supplies are located in a locked under-sink cabinet. GARAGE: The garage is kept locked and inaccessible to clients in care. A washer and dryer were observed and laundry chemicals were properly stored. The facility maintains an adequate supply of emergency food and water for all residents and staff members. BEDROOMS: There are 5 (five) total bedrooms in the facility; 2 (two) are designated as private resident rooms, 2 (two) are designated as shared resident rooms, and 1 (one) is utilized as a staff room. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Report Continued on LIC 809-C BATHROOMS: There are 2 (two) bathrooms for resident use. One common restroom and one restroom in a shared resident's room. Restrooms were observed to contain nonskid mats. Grab bars were observed in showers and next to toilets. The LPA tested the water temperature in the common bathroom, the temperature was observed to be 118.2 degrees Fahrenheit, within the required range. COMMON AREAS: This includes the living room and dining room areas. LPA observed common areas to be clean and properly furnished at the time of the visit. The living room has a properly screened fireplace. Exit doors contain alarms and all were functional at the time of the visit. OUTDOOR SPACE: The backyard has adequate shaded sitting areas with patio furniture including tables and chairs for resident use. There is a latched self-closing side gates for client use. There were no bodies of water on the premises. An outdoor shed was observed to be locked containing extra care supplies. A generator was observed outdoors for use in emergencies. Due to time constraints the LPA will return at a later time to complete the annual. No deficiencies cited. Exit interview conducted and report provided.the state’s words, verbatim · CDSS document, Jun 6, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent case management visit to deliver findings for the questionable death investigation initiated on 09/05/2024 case management visit. LPA met with Administrator Victor Hernandez and Assistant Administrator Celesty Hernandez and explained the reason for the visit. On 08/30/2024, the Woodland Hills North Adult & Senior Care Regional Office received a death report which stated Resident #1 (R1) was hospitalized on 08/17/2024, diagnosed with a urinary tract infection (UTI), and passed away on 08/30/2024 while at the hospital. The case was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Christine Ferris. On 09/05/2024, from 2:30pm to 4:30pm, Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management – Incident visit to the above facility. LPA Cortez met with Administrator Victor Hernandez and assistant Administrator Celesty Hernandez and explained the reason for the visit. The Administrator had to leave during the visit and designated the assistant Administrator to review and sign the report. The reason for the visit was to follow up on a self-reported death report received on 08/30/2024. The report pertained to the death of Resident #1 (R1). Per the information received, the circumstances surrounding the death of R1 on 08/30/2024 may be questionable and needed to be investigated. R1 was sent to the hospital 08/16/2024 and passed away on 08/30/2024 due to UTI/sepsis at the hospital. During the visit, the LPA conducted an interview with the Administrator and assistant Administrator, conducted a brief tour of the facility and obtained copies of pertinent documents. The incident was referred to Community Care Licensing Investigations Branch (IB) and assigned to investigator Christine Ferris. The LPA determined further investigation was required prior to issuing findings. Report will continue on LIC809-C, 2nd page. On 10/09/2024, from approximately 12:30pm to 3:00pm, Investigator Ferris conducted interviews with the Administrator, assistant Administrator, caregiver, residents, and resident representatives; and on 10/22/2024, at approximately 1:00pm, with Viva Home Health Licensed Vocational Nurse (LVN). In addition, St. John’s Regional Medical Center medical records, Viva Home Health medical records, County of Ventura Certificate of Death, and facility file documents related to R1 and were obtained and reviewed. A review of R1’s facility file noted R1 was admitted to the facility on 03/1/02024. The physician report dated 03/08/2024 documented R1 had mild cognitive impairment (MCI), required assistance with all activities of daily living including bathing, dressing, grooming, feeding and toileting. R1 was listed as not able to transfer to and from bed and considered to be non-ambulatory. R1’s resident appraisal dated 03/03/2024, listed R1 as bedridden with frequent UTIs (Urinary Tract Infections). The resident file also contained a Dr. order dated 05/21/2024, for a C-PAP machine due to R1’s diagnosis of obstructive sleep apnea. In addition, R1’s facility file review included St. John’s Regional Medical Center medical records which revealed R1 was seen on 04/29/2024, 12/14/2023, and 11/18/2023 for visits where R1 was diagnosed with UTIs. According to the Viva Home Health medical records, R1 was seen by home health approximately twice per week from 04/1/2024 to 08/13/2024. The home health documents listed R1’s diagnosis as Parkinson’s disease, type 2 diabetes, hyponatremia, bipolar disorder, muscle weakness, and hypertension. Per the Viva Home Health records, a visit on 08/13/2024 had no notation of illness or concern. Per the Viva Home Health Licensed Vocational Nurse, they saw nothing concerning and stated they found the facility staff to be “attentive” and the residents well cared for. According to the assistant administrator, on 08/16/2024, at approximately 2:00pm, they tried to wake R1 up for a “snack” due to R1’s diabetes, but R1’s response was reminiscent of when R1 had a prior UTI as R1 was not as responsive as usual. The assistant administrator called 911 to have R1 transported to the hospital. R1 later telephoned the hospital and was told R1 had another UTI. The assistant administrator added R1 has a history of UTIs, so they were aware of what to look for. The assistant Administrator explained R1 could verbalize if they had any pain or discomfort, but R1 did not do so on that day. Per the facility staff interviewed, R1 showed no signs of illness until 911 was called and R1 was transferred to the hospital. Report will continue on LIC809-C, 3rd page. According to the St. John’s Regional Medical Center medical records, on 08/16/2024, R1 was admitted to St. John’s Regional Medical Center with altered mental status and sepsis, suspected due to a UTI. R1’s past medical history listed paroxysmal atrial flutter/atrial fibrillation, hypertension, hyperlipidemia, type 2 diabetes mellitus, and bipolar disorder. The records revealed R1 had multiple comorbidities as listed in the discharge diagnoses such as acute hypoxemic respiratory failure, metabolic encephalopathy, and atrial fibrillation with rapid ventricular response. In addition, the records noted there were no specific symptoms related to genitourinary tract, though the patient was being treated for urosepsis. There was no concern for neglect/lack of care notated in the records. R1 was transitioned to comfort care on 08/27/2024. Comfort care measures were continued, and hospice was consulted. R1 passed away on 08/30/2024. The County of Ventura Certificate of Death listed the immediate cause of death as acute hypoxemic respiratory failure. The conditions leading to the cause of death were listed as pneumonia organism unknown, metabolic encephalopathy, urinary tract infection Escherichia coli bacterium. Other significant causes contributing but not resulting in the underlying cause were atrial fibrillation, myotonic dystrophy type 2, Parkinson’s Disease, and hypertension. The Department’s investigation did not provide sufficient evidence to substantiate neglect/lack of care. Therefore, the allegation “Neglect/Lack of Care: Staff neglected to provide an adequate level of care resulting in Resident #1 (R1) dying from sepsis while hospitalized” is deemed Unsubstantiated at this time. Exit interview, copy of report given.the state’s words, verbatim · CDSS document, Dec 3, 2024

Type of visit: Case Management - Deficiencies

At 09:35 a.m. Licensing Program Analyst (LPA) Esther Cortez, conducted an unannounced case management- deficiencies visit at the above location. LPA met with Administrator Victor Hernandez and Assistant Administrator Celesty Hernandez and explained the reason for the visit. During the Department’s investigation of death report for Resident #1 (R1) the following deficiencies were observed: The facility did not submit a Special Incident Report (SIR) to Community Care Licensing (CCL) to notify that Resident #1 (R1) was diagnosed at St. John’s Medical Center Hospital on 04/09/2024 with a Urinary Tract Infection (UTI). During today's visit, at 09:40 a.m. LPA Cortez observed two chain door locks on the front door of the home. One placed on the top region of the door and the other on the bottom region of the door. The chain door locks were removed during today's visit. Citations issued, exit interview, appeal rights given.the state’s words, verbatim · CDSS document, Dec 3, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Dec 3, 2024

87468.1(a)(6) Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following...(6) To leave or depart the facility at any time and to not be locked into any..., building...This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as the front door had two chain locks which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 3, 2024

Plan of correction: POC has been met. Door locks were removed during today's visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(B) · Plan of correction due date: Dec 5, 2024

87211 Reporting Requirements (a)(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days...(B) Any serious injury...under facility supervision. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above as they did not submit an incident report when R1 was diagnosed at St. John’s Medical Center Hospital on 04/09/2024 with a Urinary Tract Infection (UTI), which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 3, 2024

Plan of correction: The licensee will submit a plan describing how you will ensure reporting requirements are followed. Submit proof to CCL by 12/05/2024.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management – Incident visit to the above facility. The LPA met with Administrator Victor Hernandez and assistant administrator Celesty Hernandez and explained the reason for the visit. Entrance interview conducted. Administrator Victor had to leave during the visit and designated assistant administrator Celesty to review and sign the report. The reason for today's inspection is to follow up on a self-reported death report received on 08/30/2024. The report pertains to the death of Resident #1 (R1). Per the information received, the circumstances surrounding the death of Resident #1 on 08/30/2024 may be questionable and needs to be investigated. It was reported R1 was sent to the hospital on August 17th and passed away on August 30th due to UTI/Sepsis at the hospital. During today's visit, the LPA conducted an interview with the Administrator and Assistant administrator, conducted a brief tour of the facility and obtained copies of pertinent documents. This incident was referred to Community Care Licensing Investigations Branch (IB) and assigned to investigator Christine Ferris. Further investigation is required prior to issuing findings. An investigator or the LPA will return at a later date. Exit interview conducted. A copy of the report was issued to the assistant Administrator.the state’s words, verbatim · CDSS document, Sep 5, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:57 AM. LPA met with facility staff who reached out to Licensee/Administrator Victor Hernandez who arrived on site at 9:59 AM. Entrance interview conducted. Beginning at 10:00 AM, the LPA, along with Licensee/Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher is fully charged and recently serviced on 05/28/2024. Carbon monoxide detector was tested at 1:23 PM and was functional at the time of the visit. Fire alarm is centrally located and can not be shut off without the fire department on site at the facility. KITCHEN: Kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of 7 (seven) days non-perishable and 2 (two) days perishable food. Knives were observed to be locked in a drawer. Cleaning supplies are located in a locked under-sink cabinet. At 10:02 AM, LPA began checking the food supply in the kitchen pantry. All food items observed were of good quality and not expired. GARAGE: The garage is kept locked and inaccessible to clients in care. A washer and dryer were observed and laundry chemicals were properly stored. The facility maintains an adequate supply of emergency food and water for all residents and staff members. BEDROOMS: There are 5 (five) total bedrooms in the facility; 2 (two) are designated as private resident rooms, 2 (two) are designated as shared resident rooms, and 1 (one) is utilized as a staff room. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Report Continued on LIC 809-C BATHROOMS: There are 2 (two) bathrooms for resident use. Restrooms were observed to contain nonskid mats. Grab bars were observed in showers and next to toilets. At 10:06 AM, LPA tested the water temperature bathroom #1 the temperature was observed to be 108 degrees Fahrenheit. At 10:08 AM LPA tested the water temperature in bathroom #2 the temperature was observed to be 107 degrees Fahrenheit. Both bathrooms are within the required range. COMMON AREAS: This includes the living room and dining room areas. LPA observed common areas to be clean and properly furnished at the time of the visit. The living room has a properly screened fireplace. Exit doors contain alarms and all were functional at the time of the visit. OUTDOOR SPACE: The backyard has adequate sitting areas with patio furniture including tables and chairs for resident use. The exit gates were observed to be self-latching and free from obstructions. There were no bodies of water on the premises. An outdoor shed was observed to be locked containing extra care supplies. A generator was observed outdoors for use in emergencies. EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the emergency disaster plan. The facility’s policies and procedures as it pertains to emergency disasters are adequate with the last disaster drill having been conducted on 05/28/2024. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 4 (four) staff files were observed 1 (one) of which was missing their employee rights. All other staff files were complete. 6 (six) resident files were observed and all required documents were present. Resident 1 (R1) was observed to be a total care patient. The facility does not have an exemption to care for total care patients on file with Community Care Licensing at the time of this report. MEDICATION REVIEW: Medications for 2 (two) residents were observed at 11:38 AM. All medications were properly recorded on the centrally stored medication and destruction record sheet. No deficiencies were noted during medication review. Report Continued on LIC 809-C INTERVIEWS: During today's visit, LPA interviewed 2 (two) staff and 2 (two) residents. 2 (two) staff were able to appropriately answer interview questions and were knowledgeable on their roles and responsibilities as staff of a residential care facility for the elderly. 1 (One) resident stated that they had concerns about their privacy and rights. LPA spoke with the resident and staff members and ensured all parties were aware of their rights and of what is and is not required of care staff. 1 (one) resident stated that the food is very good, the activities are okay, and that the staff treat the residents very well. During today's visit, LPA obtained a copy of the facility's liability insurance. Pursuant to Title 22, CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Administrator was informed that failure to correct the deficiency may result in additional civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 17, 2024

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.