Majintin Ville

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Verly Frias, Administrator, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff members and two (2) residents present. Facility Overview: The facility is a one-story home with six (6) bedrooms and five (5) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 109.9°F. Fire extinguisher located at kitchen has current inspection tag. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for two (2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Two (2) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for two (2) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 01-20-2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Apr 9, 2026

Allegation investigated: Resident developed multiple pressure injuries while in care Facility staff is not following residents prescribed diet

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver findings of the above allegations. LPA met with Verly Frias, the Licensee. The Department's investigation involved interviews with staff and residents and review of records. On 08-25-2021, Community Care Licensing (The Department) received a complaint report with the following allegations. It was alleged that resident developed multiple pressure injuries while in care. Information received indicated that the facility staff have not provided repositioning every two (2) hours to Resident #1 (R1). LPA’s records review revealed that R1 was admitted to the facility in September 2020 under a hospice care plan. Continued on LIC9099-C.... Unsubstantiated R1 was hospitalized and passed away in August 2021. LPA conducted review of wound care progress reports dated 03-08-2021 and 08-02-2021 which revealed that R1 had three (3) pressure injuries. However, the wound care progress reports did not reveal any reason how R1 developed multiple pressure injuries. LPA conducted interviews with the Licensee and Staff #1 (S1), all of whom stated that R1 had received two (2) hour repositioning during R1’s residence at the facility. LPA attempted to obtain R1’s resident file during the facility visits. R1’s resident file was unavailable. LPA’s interview with the Licensee revealed that R1’s resident file was no long available due to expiration of resident records retention period. LPA's records review and interviews conducted did not reveal if the facility staff's neglect played any part in R1 developing multiple pressure injuries. The Department’s investigation did not provide enough information to corroborate the allegation that resident developed multiple pressure injuries while in care. This allegation is unsubstantiated. It was alleged that facility staff is not following residents prescribed diet. Information received indicated that staff provided wrong kind of nutrition formula to Resident #1 (R1). LPA’s records review revealed that R1 had a gastrostomy tube, and R1’s hospice agency was responsible for ordering and delivering the nutrition formula to the facility. LPA conducted interviews with the Licensee and Staff #1 (S1), all of whom stated that only the correct nutrition formula was provided to R1 following the instruction from R1’s hospice agency. Both the Licensee and S1 stated that R1 had received only the correct nutrition formula delivered by R1’s hospice agency. The Department’s investigation did not provide enough information to corroborate the allegation that facility staff is not following residents prescribed diet. This allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 6, 2026 · control 18-AS-20210825090919

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Seo Jeon arrived unannounced to the facility to conduct a case management visit to follow up on the resident file related to the complaint report #18-AS-20210825090919. LPA met with Verly Frias, Administrator, who allowed LPA entry. LPA was informed that two (2) residents currently reside at this facility. There were two (2) staff on duty during the time of the visit. LPA asked the Administrator about resident file document of a former resident #1 (R1) who resided in year 2021. The Administrator stated that R1's file was no longer available at the facility as it was destroyed three (3) years after termination of R1's residency. LPA toured the facility and did not observe any health and safety concerns. No deficiencies are being cited and no civil penalties per California Health & Safety Code and Code of Regulations, Title 22, Division 6. An exit interview was conducted where a copy of this report was discussed with and provided.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Carmelita McNeff, caregiver, and informed them of the purpose of the visit. At the time of the visit, there were (2) staff members and (2) residents present. Facility Overview: The facility is a one-story home with (6) bedrooms and (5) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 110°F. Fire extinguisher located at kitchen has current inspection tag. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. (2) resident files were reviewed and contained all required documentation. Licensee did not have current liability insurance. A citation was issued. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for (2) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 1-22-2025, which met department requirements. All facility exits were clear of obstructions. A citation was issued during the visit. An exit interview was conducted, during which this report was reviewed and provided along with LIC809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Apr 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of conducting the annual inspection. LPA Colvin met with Administrator/Licensee Verly Frias and informed him of the purpose of today's inspection. Below is a summary of what was observed: Infection Control: LPA Colvin observed that the facility has an updated Infection Control Plan on file and is demonstrating best practices in the facility to maintain a healthy environment for staff and residents. Such measures include soap and paper towels at hand washing stations and tight-fitting lids on trash cans. Physical Plant: LPA Colvin toured the facility and observed that there a sufficient bedrooms and bathrooms for both staff and residents. LPA Colvin observed the required furniture and linen to be present and in good condition in resident bedrooms. LPA Colvin measured the hot water in the bathroom faucets to be 109.5 degrees. LPA Colvin observed staff testing the facility's carbon monoxide alarm and smoke detectors and found them to be operational. LPA Colvin observed multiple chemicals in the cabinet under the sink, which was unlocked. Deficiency cited. LPA Colvin toured the backyard and confirmed that no exits or pathways were blocked. LPA Colvin observed sufficient supply of perishable and non-perishable food and utensils and dishes for the residents in care. Knives are kept locked up and away from resident reach. Operational Requirements: The facility has a licensed capacity of 6 non-ambulatory residents. Facility has a hospice waiver for 2 residents. LPA Colvin observed that Resident One (R1) is bedridden, and the facility does not have bedridden fire clearance. Deficiency cited. Violations of a facility's fire clearance result in an immediate civil penalty of $500, which LPA Colvin will be assessing today. LPA Colvin additionally notes that she cited the facility for the same violation on 8/27/21 during a Case Management Visit. Part of the Plan of Correction was that the Licensee/Administrator submitted a Statement of Understanding that they are not permitted to accept or retain bedridden residents without proper fire clearance. Staffing & Staff Records: LPA Colvin confirmed that there are sufficient staff present to meet the needs of residents. LPA Colvin additionally confirmed that the facility has an Administrator present at the facility. LPA Colvin observed that the Administrator's Administrator Certificate expired 4/10/24. LPA Colvin was not able to verify the submission of a renewal with the Administrator Certification Branch, but the Licensee/Administrator was able to provide LPA Colvin with a Certified Mail Return Receipt dated 2/13/24 and addressed to the Administrator Certification Branch. LPA Colvin reviewed staff records and confirmed current CPR/First Aid Certification as well as training relevant to the facility and residents' needs. Resident Records: LPA Colvin reviewed the files for all 3 current residents to confirm that they have the required information present in their files, including Physician's Report, Admissions Agreement, and current Needs & Services Plan. LPA Colvin observed that 2 of 3 residents (R2 & R3) do not have a completed Needs & Services Plan in their file. Deficiency cited. LPA Colvin observed that R2 does not have a Pre-Admission Appraisal in their file. Deficiency cited. LPA Colvin observed that R3's Admissions Agreement is missing most of the important information, such as facility information, rate for services, and services provided. Deficiency cited. Incidental Medical Services: LPA Colvin observed that resident medication is locked in a cabinet and inaccessible to residents. LPA Colvin confirmed that the facility is not retaining any residents with prohibited health conditions. Planned Activities: LPA Colvin confirmed that the facility provides activities for residents to engage in. Emergency Disaster Preparedness: LPA Colvin confirmed that the facility has an Emergency Disaster Plan on file, but is not conducting quarterly emergency disaster drills, which are to be done quarterly. Deficiency cited. Other: LPA Colvin observed that the facility has outstanding unpaid licensing fees in the amount of $989. Deficiency cited An exit interview was conducted with Administrator/Licensee Verly Frias and a copy of this report, LIC809D, LIC421IM, and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 19, 2024