Kelly's Vista Villa

Type of visit: Case Management - Other

On June 25, 2025, Licensing Program Analyst (LPA), Armando Perez made an announced visit for the purpose of the facility's closure and met with Administrator, Kelsey Cook. The Licensee initiated this closure on June 23, 2025 with effective date of closure on June 25, 2025. LPA was able to inspect the facility inside. LPA confirmed there were no residents present, and there are no personal belongings for any resident. Administrator stated the six residents were relocated to facilities associated with same Licensee. The six residents were relocated between Kelly's Cedar Villa and Mariposa Manor. Administrator stated the reason for closure is due to the 10 year lease contract not being renewed by the property owners and requested the property to be returned. The Administrator stated the original copy of the facility license was packaged during the move and will be delivering it to the Riverside Region Office within a reasonable time frame. The effective date on the license was 07/07/2015, and the facility number 374603861. LPA explained to Administrator that the license will no longer be valid, and therefore no required care and supervision should be provided in the home unless the state approves licensure in the future. An exit interview was conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 25, 2025

Allegation investigated: Staff did not address a resident's hygiene needs while in care.

/08/2025 Licensing Program Analyst (LPA) Jose Calderon provided an updated complaint investigation report to the licensee/administrator Kelly Welker via telephone. The purpose of the meeting is to clarify and provide additional information not included on the previous report dated 04/26/2025. The investigation consisted of the following: On 04/26/2025, LPA Calderon interviewed Staff S1, resident R1-R3. LPA Calderon obtained the following records: Admission agreement (dated 07/13/2022), physician report (dated 08/14/2022), grooming logs notes (brushing resident teeth) (dated 02/06/2023 to 04/26/2025), for R1. On 05/07/2025 LPA Calderon interviewed administrator, staff S2-S4 and attempted to interview witness W1-W2. Unsubstantiated The investigation revealed the following: Regarding the Allegation: Staff did not address a residents hygiene needs while in care. It is being alleged that the facility staff did not brush a resident’s teeth daily. Record reviews indicate the following: Physician report indicate that R1 is verbal and requires assistance with hygiene needs. Admission agreement indicates that R1 moved into the facility on 07/13/2022. Page 7 section 10 and 16 of the admission agreement indicates that staff will help R1 with hygiene and dental needs. The agreement does not indicate how many times per week R1’s teeth will be brushed. The facilities teeth brushing Calendar indicates that staff has brushed R1’s teeth 7 days a week from 02/06/2023 to 04/26/2025. Interviews indicate the following: Staff S1-S4 denied the allegation that R1’s hygiene needs which includes brushing of R1’s teeth daily are not addressed by staff. S1-S4 also indicates that hygiene records are kept for R1’s teeth brushing. Residents R1-R2 could not answer any questions due to health issues and were non-verbal. R3 indicates that R3 brushes their own teeth every day with no help from staff. LPA Calderon attempted to interview residents responsible persons witness W1-W2 multiple times but there were no responses. Based on interviews and supporting documentation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred therefore, the allegation of “staff did not address a residents hygiene needs while in care” is found to be Unsubstantiated. No deficiencies cited. An exit interview was conducted, and a copy of this Complaint Report was provided via email to the Licensee/Administrator Kelly Welker for signature.the state’s words, verbatim · CDSS document, May 8, 2025 · control 18-AS-20230206110201

Allegation investigated: Staff did not address a resident's hygiene needs while in care

On 04/26/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Kelly’s Vista Villa and was greeted by Staff Daniel Carballo (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the finding pertaining to the above-mentioned allegation. The investigation consisted of the following: LPA Calderon interviewed Staff S1, resident R1-R3. LPA Calderon obtained the following records: Admission agreement (dated 07/13/2022), physician report (dated 08/14/2022), grooming logs notes (brushing resident teeth) (dated 02/2023 to 04/2025), for R1. The investigation revealed the following: Unsubstantiated Regarding the Allegation: Staff did not address a residents hygiene needs while in care. This complaint alleged that the facility staff did not brush R1 teeth weekly. Records review indicate the following: Physician report indicate R1 is verbal and has health issues. Admission agreement indicates that resident moved into the facility on 07/13/2022. Admission agreement page 7 section 10 and 16 indicate that staff will help with R1 hygiene and dental needs. Agreement does not indicate how many times per week the R1 teeth will be brushed. Teeth brushing Calander indicates that staff has brushed R1 teeth 7 days a week from 02/2023 to 04/2025.Interviews indicate the following: S1 indicates that staff brush R1 teeth 7 days a week and a calendar is kept for their records. S1 indicates that they help R1 brush R1 teeth 7 days a week and keep a calendar of which staff brush R1 teeth and how often. R1-2 could not answer any questions due to health issues and was non-verbal. R3 indicates that R3 brushes R3 teeth every day with no help from staff. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff did not address a residents hygiene needs while in care” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report were provided to the Staff Daniel Carballo (S1).the state’s words, verbatim · CDSS document, Apr 26, 2025 · control 18-AS-20230206110201

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit. LPA was granted entry and met with caregiver Julia Martinez, who was informed of the purpose of the visit. At the time of the visit there was three (3) staff and five (5) residents present. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. An overall general inspection of the facility was conducted inside and out. The inspection included but was not limited to: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for clients. Facility pool was surrounded by a locked gate. Detergents, cleaning solutions, and sharp and dangerous objects were observed to be locked and inaccessible to residents in care. The smoke detector and carbon monoxide was operational, and the hot water temperature met department requirements. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed two (2) staff files and training. All staff have the required personnel records on file and criminal record clearance and updated training along with CPR/First Aid. Three (3) resident files were reviewed and possessed all required paperwork which included Admissions Agreement, Needs and Service Plan, and Physician's Report. The listed administrator possesses a current administrator's certificate. Resident medication was centrally stored and locked in a cabinet. LPA reviewed medications prescribed to the residents and found all medication with required labeling found to be in place. LPA reviewed the facility's emergency and disaster plan, and infection control plan. Fire extinguishers were fully charged and inspected. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided to caregiver Martinez.the state’s words, verbatim · CDSS document, Jul 18, 2024