La Valhalla Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Fred De Vera, Caregiver. Administrator Jonathan De Vera arrived shortly after. According to the facility’s license, the facility has a maximum capacity of six residents, of all whom may be non-ambulatory and one of which may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Residents bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per De Vera, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kits were complete and readily accessible. Deficiencies were observed and cited on today's visit. LPA provided consultation during the inspection. An exit interview was conducted with Fred De Vera, Caregiver, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Nov 13, 2025

Allegation investigated: Staff neglect, resulting in pressure injuries Staff did not treat resident with dignity Staff did not meet resident's incontinent needs

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and was allowed entry into the facility by Staff, Rowena Ramos. Administrator, Jonathan de Vera arrived during the visit. During the investigation, LPA briefly toured the facility, reviewed records, and interviewed staff and residents. It was alleged that staff neglect resulted in a pressure injury and staff did not meet resident's incontinent needs. It was reported Resident #1 (R1) sustained pressure injuries at the facility. The facility staff indicated R1 had a heat rash, not pressure injuries. R1 confirmed they had heat rash under their breast, between their inner thighs and on their buttocks area. R1 was unable to distinguish the difference between a pressure injury and a rash. LPA observed the areas on R1, which appeared reddened and flaky. R1 explained the facility staff were applying ointment and addressing the rash, as well as their home health agency. On 10/24/25, R1 was transported to hospital due to their catheter leaking. On 10/29/25, LPA spoke with a hospital staff member and verified that R1 did not have any identified or documented pressure injuries. Continued on LIC 9099C. Unsubstantiated R1 confirmed they went to the hospital multiple times due to their catheter leaking, which needed to be replaced. R1 also stated once the catheter was replaced there were other issues with their catheter, and they had to return 3 days in a row to the hospital for catheter assistance. R1 wore briefs in addition to the use of the catheter. R1 confirmed their briefs were being changed by staff and their urine bag was emptied. R1 stated their incontinent care needs were met by the facility staff. Facility staff interviews confirmed they applied ointment provided by R1’s nurse, changed R1’s briefs and emptied R1’s urine bag. Staff also explained that due to the catheter leaking, the urine would leak into R1’s diaper. However, staff changed R1’s briefs on regular basis. Staff also stated they changed R1’s briefs, 15 times in one day, to ensure R1 stayed dry due to the leakage from the catheter. It was also alleged that staff did not treat a resident with dignity. It was reported staff were mean to R1, called resident names and told R1 they won’t help R1 anymore. R1 denied the allegation and stated staff treated them well and were very attentive to R1’s needs. Staff explained one day R1 returned to the facility from the hospital. That day, R1 needed a brief change upon return. However, staff told R1 to wait, as the other caregiver was about to arrive at the facility to assist. R1 required a 2-person assist for safety reasons. Staff stated the facility has a Hoyer lift but R1 refused to use it. Therefore, the other staff were needed. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Rowena Ramos whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Nov 4, 2025 · control 08-AS-20251027113714

Allegation investigated: Staff did not render resident with timely medical care Staff did not meet resident’s care needs. Staff did not treat resident with respect

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to initiate a complaint investigation on the above-mentioned allegations. LPA met Caregiver Rowena Ramos and discussed the purpose of the visit. LPA spoke with Administrator Jonathan De Vera via facetime and he arrived at the facility. On September 15, 2025, Community Care Licensing (CCL) received a complaint alleging staff did not provide Resident 1’s (R1) with timely medical care needs, staff did not meet R1’s care needs and staff did not treat R1 with respect. During the investigation, LPA Strong conducted internal and external interviews, and reviewed facility records. According to the allegation prior to September 13, 2025, Resident 1 (R1) was not rendered timely catheter care needs which resulted in hospitalization. Unsubstantiated Interview with an outside source confirmed R1 was receiving catheter care from home health agency since June of 2025. Records collected revealed R1 has made multiple visits to the emergency department to receive medical care for catheter, dating back to June of 2025. Interview with home health agency confirmed that R1 has been receiving such care. Interview with Administrator established that R1 received emergency medical care on September 12, 2025, as soon as R1 expressed severe pain. Details of the second allegation state that R1 did not receive nighttime assistance and was left wet due to incontinence. Interview with R1 revealed staff respond to nighttime call systems quickly and continuously. R1 stated there are no issues with nighttime care or routine changes. Staff established that R1 is changed often, throughout the day. Interview with staff revealed that they have not ignored any nighttime calls and have help R1 when asked. Interview with an outside source revealed that there are no concerns with the care received by staff at the facility. Lastly, it was alleged that R1 was yelled at by nighttime staff. Interview with R1 established that R1 has not been yelled at. Interview with other residents did not reveal any history of verbal abuse. Interview with outside source did not reveal any information to corroborate that facility staff yell at residents. Based on interviews, and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Caregiver Jonathan de Vera, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.the state’s words, verbatim · CDSS document, Sep 19, 2025 · control 08-AS-20250915114726

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Rowena Ramos. Administrator Jonathan De Vera arrived shortly after. According to the facility’s license, the facility has a maximum capacity of six residents, of all whom may be non-ambulatory and one of which may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Residents bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per Jonathan, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kits were complete and readily accessible. No deficiencies were cited on today's visit. LPA provided consultation during the inspection regarding volunteers at the facility. An exit interview was conducted with Administrator Jonathan De Vera, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Nov 20, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Ferdinand De Vera and Caregiver Ofelia DeVera. According to the facility’s license, the facility has a maximum capacity of six (6) residents, all of whom may be non-ambulatory and one may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per Caregiver, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Caregiver Ferdinand De Vera, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Nov 21, 2023