Hansell Villa

Type of visit: POC

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced POC case management visit to clear deficiencies cited on 07/09/2026 during an annual inspection visit. One of the deficiency cited is for California Code of Regulations (CCR) Title 22 §87405. §87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1)(2) (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. During todays visit, LPA Partoza, cleared the above deficiency and obtain certificate as proof of training for CCR Title 22 Section 87405 Administrator Qualification (d)(1) to (2). POC letters were provided to LIC/ADM. No deficiencies were cited during today's visit and a copy of the report was provided to Designated Administrator (ADM) Elizabeth Bautista.the state’s words, verbatim · CDSS document, Sep 17, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced POC case management visit to clear deficiencies cited on 07/09/2026 during an annual inspection visit. The following deficiencies were cited: 87465(h)(5)Incidental Medical and Dental Care Services (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 87623 Indwelling Urinary Catheter (a)The licensee shall be permitted to accept or retain a resident who requires the use of an indwelling catheter under the following circumstances: (1)If the resident is physically and mentally capable of caring for all aspects of the condition except insertion and irrigation. 87463 Reappraisals (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment 87463 Reappraisals (a)The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months... During todays visit, LPA toured the facility and verified documents. LPA Partoza, is not able clear one of deficiency during today's visit. LPA requested that LIC/ADM obtain or secure refresher course certificate as proof of training for CCR Title 22 Section 87405 Administrator Qualification (d)(1) to (2). POC letters were provided to LIC/ADM. No deficiencies were cited during today's visit and a copy of the report was provided to Designated Administrator (ADM) Elizabeth Bautista.the state’s words, verbatim · CDSS document, Aug 6, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced POC case management visit to clear deficiencies cited on 07/09/2026 during an annual inspection visit. The following deficiencies were cited: 87303 Maintenance and Operation(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors 87307 Personal Accommodations and Services(d)(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. During todays visit, toured the facility and verified documents. LPA Partoza, is not able clear all the deficiencies during the time of the visit. The physician's reports are pending from the medical provider. Deficiencies will be cleared once requirements are cleared after review. LPA verified that ADM is currently working on completing supporting documents based on the POC. LPA provided guidance for the exception request of prohibited health condition. No deficiencies were cited during today's visit and a copy of the report was provided to Designated Administrator (ADM) Elizabeth Bautista.the state’s words, verbatim · CDSS document, Jul 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual required inspection and met with administrator (ADM) Elizabeth Bautista and stated the purpose of the visit. The facility is licensed to serve adults 60 and over; approved for 6 non-ambulatory, 1 maybe bedridden in room #2 and hospice waiver for 4. LPA observed residents and staff present, 6 out 6 residents were in their room resting. 5 out of 6 are non-ambulatory and 1 out of 6 is ambulatory. LPA toured the facility, including common areas, resident rooms, kitchen, bathrooms, driveway, and outdoor spaces and storage areas. Indoor temperature was within acceptable range of 70°F. The kitchen was sanitary and organized; knives and chemicals were locked. Food supply met requirements (2 days perishable, 7 days non-perishable). Kitchen water temperature measured at 123.1°F. Bathroom water temperature measured at 120°F. A technical assistance was provided to ADM for the kitchen hot water temperature. LPA inspected the refrigerator and the temperature gauge inside the refrigerator reads at 40° F. The freezer temperature is at 0°F. Medications were locked and inaccessible to residents. However, staff has pre-poured medication in an unlocked drawer for each resident to be given at a later time of the day. LPA observed medication were in a clear covered plastic container with residents name and AM/PM schedule. LPA inspected the interior of the facility and observed the following. The facility has a total of 4 bedrooms, 2 out of 4 bedroom are single occupancy and 2 out of 4 are shared. Bathrooms had grab bars and non-skid mats. Resident's have storage that are sufficient to store personal items. page 1 of 2 LPA observed that all residents were using hospital beds with half bed rails. LPA observed wheelchairs parked in the living room area for resident's use. The walkways and hallways were free from obstruction and tripping hazard. LPA observed that 2 out of 6 resident (R1 and R3) uses indwelling urinary catheters. ADM stated that R1 is visited by a home health care nurse once every two weeks and R3 is checked at the hospital. ADM stated that staff empties R1 and R3s urine collector bag. Based on interview zero out of the six resident are receiving hospice care and zero out of the six residents are bedridden. LPA inspected the exterior of the facility and observed the following: An unused mattress and metal bedding leaning on the wall by room #3 that obstructed the walkway when exiting and turning right from room #3. A low hanging tree branch was obstructing the pathway towards the walkway. The living room has a sliding door that directly access the tomato patch garden. The sliding door in the living room when opened was stuck and not easily opened. The screen sliding door from Room #2 was not aligned and hangs sideways. LPA reviewed 6 resident and 4 staff records, including medication logs, admission agreements, care plans, personal and incidentals, health screenings, and training. 4 out of 4 staff have required clearances and certifications and training, however, 4 out of 4 staff record of training did not have a date when it was provided. A technical assistance was provided to ADM. Based on record review R1 and R6 were diagnosed with dementia. R1 and R6s medical assessment (LIC 602) was dated October 2023. Based on record review R1 and R6 appraisal needs and services plan (LIC 625) was dated January 2025, and missing the resident or their responsible party's signature. The facility conducts fire and earthquake drill quarterly for each shift. Last drill practice training was conducted on different dates and times of January 2026. The facility is equipped with panel fire alarm system and a fire extinguisher inspected on 05/21/2026. Deficiencies are being cited during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted with ADM Elizabeth Bautista. A copy of the report and appeals rights was provided. end of report page 2 of 2the state’s words, verbatim · CDSS document, Jul 9, 2026

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: POC

On 08/04/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Plan of Correction (POC) visit. LPA announced the purpose of the visit and met with Elizabeth Bautista, Administrator. LPA observed 1 resident in the kitchen and 2 staff. On 07/30/24 the facility was cited for Type A 87632 (a) Hospice Care Waiver, Type A and 87405 Administrator - Qualifications and Duties. The facility was granted a Hospice Waiver for 4 residents. on 07/17/25 the facility was cited for Type B 87211 Reporting Requirements and Type A 87465 Incidental Medical and Dental Care (h)(6). On 08/04/25, LPA conducted a POC visit to clear the Type A and Type B POC's. LPA received a copy of the facility's plan of corrections. A copy of the Letter of Deficiencies Cleared letter was provided. No deficiencies cited during today's visit. This report was reviewed with Administrator Elizabeth Bautista and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Aug 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Elizabeth Bautista, Administrator. LPA announced the purpose of the visit. LPA observed 2 staff and 4 residents, 1 resident is currently hospitalized. During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed a garage with laundry area and separate pantry for residents and staff food storage. LPA observed a staff lounge area for staff to use on breaks and lunches. LPA toured 4 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. ADM tested the smoke detector in the hallway and found to function properly when tested. The facility has a pull fire alarm last serviced on 05/16/25 LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 118-119 degrees F. Page 1 of 2 Page 2 of 2 LPA toured the outside area and found the exits to be clear of obstructions. LPA observed fire extinguisher was last serviced on 03/15/2024. LPA reviewed Fire and Earthquake log. The Facility last disaster drill was last conducted on 05/30/25 LPA reviewed resident records for 3 out of 4 residents.. LPA reviewed 3 staff records. ADM and LPA reviewed Centrally Stored Medication Record for 3 residents. During visit LPA observed R1 medication record was not update from 01/16/25 which poses an immediate health and safety risk for resident in care. ADM did not report R1s refusal of medication to the department within 7 days of occurrence. ADM stated resident has been refusing medication (Tam) since it was prescribed on 03/28/25. Deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Elizabeth Bautista and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 17, 2025

Allegation investigated: Staff are not maintaining resident's hygiene Staff are not turning the resident to prevent pressure wounds Staff are not dressing the resident Facility is not providing resident records to resident representative

On 1/23/2025 Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit at the facility. LPA met with Care Staff Nida Agbayani and explained the purpose of the visit. Regarding the allegation of staff are not maintaining resident's hygiene, Reporting Party (RP) stated that they have found client (R1) with fecal matter under nails on bed and on clothing. Per RP care home staff reports that client is mean, aggressive, and angry and scratches staff. LPA Maruffo was able to interview three staff members, according to S1, they always check R1s diapers every time. If we smelled not good, we would need to check. If S1 tried to feed R1, R1 would scratch us and say get out of my room. R1 did not have dirty fingernails. R1 never had feces in his/her fingernails. R1 did not have stains on the bed or sheets and on her clothes. S2 also shared that his/her family (F1) gave R1 a bed bath. No, we would not shower R1 because he/she refused. R1 said no, get out. R1 doesn’t listen to the care giver, only listens F1. page 1 of 3 Unsubstantiated S2 never noticed any dirt or anything underneath R1s fingernails. R1 never scratched his/her butt. R1 never had any poo stains on him/her or bed sheets or on the clothes. S1 and S3 mentioned that the beddings are changed three times a week. Additionally, LPA Maruffo interviewed four residents. R2 stated that staff assists a little bit. They assist with bathing. They may change the beddings when R2 is out in the kitchen eating. Usually, they clean R2s clothes every day or every two days. They bathe R2 every morning and R2brushes his/her own teeth. R3 shared that the staff showers him/her. R3 is showered two times per week. The staff help R3 brush his/her teeth. They change my diaper out. They change my diaper every other day. R4 mentioned that staff cleans his/her bedding. They clean R4s bedding every day. They throw out the old pads and put the new stuff in. R4 doesn’t know how often they clean the bedsheets. Staff cleans R4s clothes every day. R5 mentioned that someone comes in and does cleaning. Someone comes in at night and changes the bed sheets. R5 has never seen them (bedsheets) dirty or anything. Staff cleans R5s clothes whenever he/she needs it. Regarding the allegation of staff are not turning the resident to prevent pressure wounds, RP stated that the physical therapist (PT) came out there after Memorial Day and told them they have to reposition R1 every couple hours and not once have they done it. According to interviews, S1 stated that R1 is required to be turned in bed. S1 would turn R1 every two to three hours around the clock. That was the advice of the administrator. R1 did not have any bed sores. S2 also added that R1 required to be turned every 3 hours. Staff would turn R1 every 3 hours. S3 also shared that R1 is required to be turned. S3 always tell staff to turn the clients every two hours to avoid bed sores. R1 did not get any bed sores. Based on records review, on the visit notes, visit done by PT on 5/23/2023, it was noted that R1 was confused and resistive, unable to get vital signs due to agitation. Educated caregiver for bed mobility. Regarding the allegation of staff are not dressing the resident, RP stated that not once have they changed R1s top, R1 has been in the facility for 21 days. page 2 of 3 Based on the interviews, R2 stated that staff usually has R2 dressed in pants and t shirt. R3 mentioned that the staff do not put pants on him/her. R2 says if he/she has a visitor, they will put pants on R3) R3 nods to confirm what R2 said. R4 mentioned that he/she usually have shirts and pants on. R5 shared that he/she dress himself/herself. For the staff interviews, S1 mentioned that they change the residents clothing every morning. R3 doesn’t wear pants. R4 has jeans. If R4 wants to go to sleep, he/she tells staff to remove his/her pants. R4 wants to remove his/her pants after lunch because he/she doesn’t like to have them on. S1 also shared that they did not put pants on R1. R1 did not want them. When staff tried to put pants on R1, R1 would shout at staff. R1 only wanted his/her blouse and the diapers. According to S2, they dress the residents. The residents are fully dressed with shirts and pants every day. R3 doesn’t have pants on because it is hot. R3 always covers himself/herself with blanket because it is too hot. R4 takes off his/her pants this afternoon and at 3PM S2 changes the diaper and put back on the pants. S3 added that R1 refused to put his/her pants on. R1 has a long gown on and shirt. R1 said that he/she is not comfortable putting on the pants. Regarding the allegation of facility is not providing resident records to resident representative, RP stated that he/she signed the paperwork on May 12, 2023 and did not get a copy. On June 1st, RP requested copies of the paperwork from the administrator in person and in text. RP sent another text reminding the administrator to provide copies of the documents. He/she has not responded to the requests. According to S3,it was mentioned that they no longer have R1's file because it was given to the paramedics when they arrived to pick R1 up and send R1 to respite care. S3 said they will be able to return the file to me. R1s family member never asked me for the records. Based on records review, LPA Marrufo was able to obtain the files of R1 which was faxed to LPA by the facility. Records obtained were physicians report, admission agreement, needs and services plan, emergency information. Based on interviews and records review, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Report is reviewed and copy is provided. page 3 of 3the state’s words, verbatim · CDSS document, Jan 23, 2025 · control 26-AS-20230609132651

Type of visit: Required - 1 Year

On 7/30/2024 at 2:00 p.m.. Licensing Program Analyst (LPA) Maria (Mita) Partoza arrived and conducted an unannounced required 1 year inspection visit. LPA was greeted by 2 staff and administrator Elizabeth Bautista. LPA stated the purpose of the visit. LPA observed a NO SMOKING OXYGEN IN USE sign posted on the exterior of the facility and 2 of 4 resident's room door. ADM stated oxygen is used by resident in room 2 and 4 as needed only. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over 6 non-ambulatory, 1 out 6 may be bedridden and a waiver for 2 hospice care. The facility's has 6 residents (R1 to R6) that have neurocognitive impairment. 2 staff were present at the time of the visit. 6 residents were present at the facility and 1of 6 were in the living/dining area. LPA observed 5 of 6 residents are in the bedroom and 1 out of 6 residents are under hospice care. Based on document review, the facility does not have a waiver for hospice care. At 2:15 p.m. LPA toured the facility inside and outside with ADM, including but not limited to the kitchen, bathroom, dining room, living room, residents rooms, staff room, backyard and walkways. LPA observed the Personal Rights disclosure, Long Term Care Ombudsman (LTCO) and Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) prominently posted on the wall, visible to visitors, resident and staff. The temperature inside the home was at 68 to 69.8 degrees F. LPA and ADM toured the 4 bedrooms and LPA observed the rooms to be organized and free from debris and has sufficient storage for resident's personal belongings. Resident's bedroom has a call alarm system to alert staff if assistance is needed. Three resident bedrooms (Rooms #2 and 3) have sliding exit doors that are free from obstruction. 2 of 4 bedroom is shared by 2 residents. LPA observed 6 of 6 residents' bedroom are sanitary and free from debris. page 1 - see LIC 809C for page 2 *due to technical difficulty while saving the document the ADMs signature was not captured. Based on observation R1 who is under hospice care is able to move from side to side, is able to do 1 or 2 activity of daily living such as eating, drinking and stand with assistance. LPA observed that the facility has a wall pull fire alarm system but it is not connected to the fire department emergency line. The facility has a carbon monoxide alert system that is in good working condition. LPA observed night lights on the hallway. Hallways are free from obstruction. LPA observed ramps and walkways are free from obstruction. LPA observed the backyard area to be free from debris and is maintained. LPA with ADM toured 2 full bathrooms and both have non-skid mats and grab bars and a raised toilet seat. The facility stores incontinent supplies and unopened, unused cleaning and laundry supplies are kept in a locked cabinet inside the garage. LPA with ADM inspected the staff lounge inside the garage. LPA tested the water temperature for kitchen and bathrooms, water temperature was measured at 118.9 degree F to 121.9 degree F. Dining and kitchen area and living room area were observed to be sanitary and organized. The facility has sufficient supply of perishable food for 2 days and non-perishable food for 7 days. The fire extinguisher located in the kitchen was last inspected on 3/16/2024. LPA Reviewed 3 of 6 resident's record and observed them to be complete and up to date, including Centrally Stored Medication and Destruction Record (CSMDR). LPA reviewed 2 staff records and observed the record to be updated. The facility's last disaster drill training was conducted 1/3/2024 1/24/2024, 2/10/2024 and 6/10/2024. LPA discussed with ADM hospice waiver requirement, housekeeping and record maintenance. Deficiency is being cited during today's visit per California Code of Regulation (CCR) Title 22, article 87632 (a).See LIC 809D. An exit interview was conducted with ADM Elizabeth Bautista. A copy of the report and appeals rights were provided. Due to technical difficulty, LIC 809C did not save. *due to technical difficulty while saving the document the ADMs signature was not captured. page 2 of 2 end of reportthe state’s words, verbatim · CDSS document, Jul 30, 2024