Lily of the Valley

Type of visit: POC

Licensing Program Analysts (LPA) Leslie Ngo-Castaneda met with facility licensee Rudy Espino for a Plan Of Correction (POC) visit. The purpose of the POC visit is to make sure deficiencies were corrected on reports issued on 8.20.2025. Entrance interview conducted. LPA toured the home and requested the following: -HSC 1569.695(a)(7)(E) POC: Medication in the refrigerator needs to be kept locked and inaccessible at all times. POC date 9.9.2025: LPA observed lock box inside the refrigerator for OTC and rx. - CCR 87335(e) POC: S4 needs fingerprint clearance. POC date: S4 is fingerprinted and cleared since 8.22.2025. Exit interview conducted and copy of this report was printed and given.the state’s words, verbatim · CDSS document, Sep 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff designee, Anthony Espino and explained the reason for the visit. At 10:03 AM, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 10:29 AM smoke alarms were tested and are operational. There are carbon monoxide detectors that functions properly. The fire extinguisher is beside the kitchen and living room. During the visit the facility is at 80 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory; hospice waiver for one (1). Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in the dining area cabinets. Bedrooms: There were five (5) bedrooms designated for clients' and staff use. Four (4) of the that are in use by clients were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Room #1 and #3 are properly furnished and is for private used. Bedroom #2 and bedroom #4 are shared. There are one (1) staff bedroom in the facility and is located beside bedroom #4, staff bedrooms are locked with no medication in sight. Continue to LIC 809-C Bathrooms: There are three (3) bathrooms designated for residents' and staff use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 109.0 degrees Fahrenheit for bathroom #1 located in the hallway beside bedroom #2. Bathroom #2 measured 108.5 degrees Fahrenheit inside bedroom #4. Bathroom #3 is located inside staff bedroom. Cleaning supplies are being stored in a locked cabinet in the laundry room. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Residents dining table fits enough for six (6). Office space is beside the living room. Fireplace is block-off, non-operational and inaccessible to residents. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area and detergents are located by the laundry room by the kitchen that is kept secured. The facility does have a swimming pool or body of water. The garage is detached and is used for storage. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Staff #4 (S4) was observed assisting R1 to go to a doctor appointment today and is observed to not be finger print cleared, civil penalty will be issued at LIC 421BG. Medications: Medication and Medication Records (MMR) were review for proper documentation. LPA observe R1 Epi pen and PRN Pepto Bismol was kept unlocked and accessible in the refrigerator. Deficiency will be issued in LIC 809-D. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies and civil penalty observed during the visit. Exit interview conducted and a copy of the report issued.the state’s words, verbatim · CDSS document, Aug 20, 2025

Type of visit: POC

In conjunction with annual inspection visit. LPAs Mariana Agban and Michael Cave conducted POC Visit. On 08/06/2024 the Licensee was cited for converting the garage to a room with a private bathroom without obtaining permits. During today's annual inspection, LPAs observed the room that was converted was demolished. Administrator confirmed that no staff or residents are residing at that room. Exit interview conducted. POC is cleared and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Sep 26, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted an Annual Required visit and inspection of the facility. LPAs met with staff, and explained the reason for the visit. Administrator, Rody Espino was contacted by staff and arrived shortly after. At approximately 11:15 am, with the assistance of staff, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are interconnected and battery-operated. There is a carbon monoxide detector that functions properly installed in the hallway between resident rooms. Common Areas: This includes the living room dining areas were appropriately furnished and lighting was adequate. The living room has a television and comfortable furniture. Properly labeled medications were locked in one of the living room cabinets. The fireplace was observed with a screen and glass covering. There were no tools present. According to the Administrator, the fireplace is never in use. LPAs did not observe any keys or turn on the switch to operate the fireplace, accessible to residents at the time of the visit Kitchen: The kitchen appliances and fixtures were functional. LPAs found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. LPAs observed fully stocked first aid kit and fire extinguisher in the kitchen with a purchase date of 07/11/24. Bedrooms: There were four(4) bedrooms designated for residents' use. One (1) bedroom is designated for staff use. All four (4) bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 111.4 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. (Continue 809C) Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. There is a swimming pool that is fenced all around its parameters. The fence was at least five foot high with a gate, that is also five foot high. The gate was observed locked, making it inaccessible to residents to enter. Resident Files: LPAs conducted a file review of resident records to ensure compliance of licensing forms. Staff Files: LPAs also conducted a file review of staff records to ensure forms and training are up to date and compliant with licensing forms. Medications: Medication and Medication Records were reviewed for proper documentation. Temperature: Facility maintains a comfortable temperature of 77 degrees Fahrenheit Garage: On 08/06/2024 the Licensee was cited for converting the garage to a room with a private bathroom without obtaining permits. During today's annual inspection, LPAs observed the room that was converted was demolished. Administrator confirmed that no staff or residents are residing in that room. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issuedthe state’s words, verbatim · CDSS document, Sep 26, 2024

Type of visit: Office

An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional office. The purpose of this Informal Conference is to discuss the incident that occurred during 2020 Present at today's meeting are the following: · Eva Miller, Licensing Program Manager (LPM) · Mariana Agban, Licensing Program Analyst (LPA) · Rody Espino – Administrator The informal conference process was explained to the Licensee. The Licensee was also informed that this Informal Conference is a part of the administrative action process. Further citations may result in a Non-Compliance Conference, which could lead to a referral to the Department's Legal Division for possible license revocation or other administrative actions. BRIEF HISTORY: The facility has been in operation since licensure on 08/30/2005 and is licensed for six non-ambulatory residents, hospice waiver for 1. On 09/14/23 LPA Agban conducted an annual Required visit and inspection of the facility. LPA also observed a room outside in the backyard next to the pool that has a hospital bed and a private bathroom. This room was not indicated on the facility sketch as a resident room. LPA also observed that the garage had been converted to a room with a private bathroom. A review of facility sketch does not indicate that there is a room created in the garage. Interview with the administrator revealed that the room was built during COVID-19 for staff for isolation in case of contact. During today’s meeting, LPA cited the facility on CCR section 87305 - Alterations to Existing Buildings or New Facilities (a)Prior to construction or alterations, all facilities shall obtain a building permit. (Continue 809 C) LPM Miller discussed and expressed concerns regarding adding additional rooms to the property without notifying CCL. LPM Miller also emphasizes the importance of properly reporting any changes or incidents occurring in the facility. The Licensee was informed that Community Care Licensing (CCL) shall continue to frequently monitor the facility as often as necessary to ensure the Licensee's compliance with Title 22 Regulations Exit interview conducted, and a copy of the report was given.the state’s words, verbatim · CDSS document, Aug 6, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: Sep 6, 2024

87305 - Alterations to Existing Buildings or New Facilities (a)Prior to construction or alterations, all facilities shall obtain a building permit. Based on LPA's observation on 09/14/2023 and information obtained the Licensee had converted the garage to a room with a private bathroom without obtaining permits. This poses potential risk to the personal rights of the residents in carethe state’s words, verbatim · CDSS document, Aug 6, 2024

Plan of correction: The licensee agreed to obtain permits and proper inspections from the city. The licensee will email all necessary documents to the LPA by the POC date.