Midtown Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Jarred Torres, and LPA, Robert Campbell, conducted an unannounced annual inspection. Upon entry, The LPAs introduced themselves and explained the purpose for the visit. The LPAs met with Administrator, Romeo Labastida. The facility is a two-story home with 102 bedrooms for residents. The facility is currently operating at a census of 25 residents. There are no known firearms on the premises. There is no pool and there are no bodies of water on the premises. The LPAs observed hygiene and cleaning supplies in the facility, which were locked and kept separate from food supplies. The facility has an approved infection control plan on file. During the tour, the LPAs smelled a gas leak, which was confirmed by the Administrator and SoCal Gas Company, whom showed up in person to assess the leak. Although the bedrooms had furniture in good repair, the LPAs observed rust in a resident's shower, broken blinds in four resident bedrooms, and a rusted fence around the perimeter of the facility which was locked from the inside. A deficiency will be issued for these issues. Please refer to the LIC 809-D. The outdoor area had no tripping hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. The carbon monoxide detectors were operational, and the hot water temperature was measured at 110°F. The fire extinguishers were observed to be in good condition with the last service being completed on 8/19/2025. Continued on LIC 809-C... The LPAs observed the kitchen to have the required two day supply of perishable foods and a seven day supply of non-perishable foods on the premises. There was food debris on the floor, white crusty residue on the ice machine, and a black and brown substance coating the vent above the kitchen range. These issues were discussed with the Administrator, and a deficiency will be issued. The LPAs observed that adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. The LPAs reviewed files for five staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five resident files were reviewed and contained all required documentation. The LPAs observed that the centrally stored medication supply was securely locked and inaccessible to clients in care. Medications for five residents were reviewed and the LPAs confirmed that all medications were listed on the Medication Administration Record and accounted for. The LPAs reviewed the facility’s approved emergency and disaster plan, including documentation that the next fire drill is scheduled for March 5, 2026. All facility exits were clear of obstructions. Two deficiencies were cited and an exit interview was conducted. A copy of this report was discussed and provided to the Administrator, Romeo Labastida, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Feb 26, 2026

Type of visit: POC

On 11/10/25 Licensing Program Analyst (LPA) Javina George made an unannounced Proof of Corrections visit. LPA was greeted and granted entry by House Manager Kailene Martinez, where LPA explained the purpose of the visit. On 10/24/25 LPA conducted a case management deficiencies visit where the facility was cited regulation 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. While conducting a tour inside the kitchen LPA observed for there to be a trash bag tapped to the ceiling. Inside the same area above a 2-3 tier rack. LPA observed for there to be piece of ceiling/material hanging out of a hole. LPA was informed it it believed to be connected to the leak that was upstairs inside the bathroom. During today's visit (11/1025), LPA conducted a tour of the kitchen where LPA observed for the trash bag to be removed and the ceiling to not have any visible holes. There was white paint indicating where the repairs were. No additional citations were issued and the POC cleared letter was provided during today's visit. An exit interview was conducted where a copy of this report was reviewed and provided to Kailene Martinez, House Manager.the state’s words, verbatim · CDSS document, Nov 10, 2025

Type of visit: Case Management - Deficiencies

On 10/24/25 Licensing Program Analyst (LPA) Javina George conducted an unannounced case management deficiencies visit. LPA was at the facility initiating a complaint investigation. LPA conducted a walk thru of the facility and observed in kitchen for there to be black trash bags taped to the ceiling right next to a light fixture directly above the kitchen sink. LPA inquired as to what happened and how long has there been a trash bag tapped to the ceiling. Inside the same area above a 2-3 tier rack. LPA observed for there to be piece of ceiling/material hanging out of a hole. LPA asked staff what happened and it was reported that there was a leak upstairs in the bathroom. LPA was informed it it believed to be connected to the leak that was upstairs. Per House Manager Kailene Martinez, the ceiling has been in the condition for a couple of days. LPA requested copies of any maintenance requests or work orders, as well as an invoice quotes for the repair. House Manager stated that the facility was in the process of obtaining quotes. House Manager then contacted the owner who did not have any invoices to provide, but stated that ceiling would be repaired next week. Based on observations and interviews a deficiency is being cited issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8) on the attached 809D. An exit interview was conducted where a copy of this report, appeal rights,and LIC9098-Proof of Corrections form was reviewed and provided to Kailene Martinez, House Manager.the state’s words, verbatim · CDSS document, Oct 24, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 6, 2025

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. This requirement is not met as evidenced by: the ceiling was not repaired from an identifed leak. This poses a potential health safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 24, 2025

Plan of correction: The licensee agreed to have the ceiling repaired next week. Proof of POC is to be submitted to the department by 5pm on the due date indicated.

Type of visit: Case Management - Deficiencies

On 9/5/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 18-AS-20250826103251. LPA met with House Manager, Kailene Martinez and explained to Kailene the purpose of LPA's visit. During residents records review, LPA observed (4) four out of (5) five residents did not have a signed admissions agreement and/or admission agreement was not fully completed. Based on record review and interviews, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809-D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to House Manager, Kailene Martinez..the state’s words, verbatim · CDSS document, Sep 5, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Sep 19, 2025

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met evidence by: Based on records review, the licensee did not maintain complete admission agreement for (4) four out of (5) five residents.The agreement was incomplete and missing required signatures This poses a potential risk for the residents rights and care, as incomplete records do not clearly establish agreed-upon terms.the state’s words, verbatim · CDSS document, Sep 5, 2025

Plan of correction: Licensee shall ensure all resident records are completed, including signed admission agreements with all the required information. Licensee will review and update all resident files and submit copies of complete admission agreements for current residents to LPA via email by Close of Business.

Allegation investigated: Staff took away resident's personal items

On 9/04/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering complaint investigative findings into the allegation listed above. LPA Flores met with House Manager, Kailene Martinez, and explained the purpose of the visit and a tour of the facility was conducted. It was reported staff took away Resident #1 (R1) personal items. LPA’s investigative process consisted of records review and interviews. Through record reviews, an in-house incident report detailed on 3/26/2025, Staff #1 (S1) assisted R1 with setting up R1’S computer. R1 became aggressive and allegedly threw R1 phone at S1. S1 reported they took away R1’s cellphone and computer and locked it away from R1 for safety. The facility staff did not comply with Title 22, Section 87468.1, Personal Rights of Residents in All Facilities, by S1 depriving R1 of R1’s computer and cellphone. (Continue to LIC9099C...) Substantiated (Continuation from LIC9099) Based on records review and interviews, the preponderance of evidence standard has been met. Therefore, the above allegation is substantiated. California Code of Regulations Title 22 is being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report along with the LIC 9099D, and appeal rights were reviewed and provided to Administrator, Kathleen Hyland. (Continuation from LIC9099) LPA attempted to interview R1, however R1 no longer resides at the facility, and attempts to contact R1 were unsuccessful. A random sample of residents were interviewed, where 4 of 4 residents reported not having any concerns at the facility. It was further alleged staff did not provide activities to R1. Records review of the facility’s monthly activity log was completed. The activity log divulged two activities a day are provided for the residents in care. Through staff interviews, it was reported R1 refused to participate in planned activities and preferred to stay in their room. LPA attempted to interview R1, however R1 no longer resides at the facility, and attempts to contact R1 were unsuccessful. A random sample of residents were conducted, where 3 of 4 residents reported participating in activities. The remaining interview revealed 1 of 4 reported they no longer wanted to participate in the interview; therefore, the question regarding activities was not answered. Based on records review and interviews, the allegations are unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened and/or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted, and a copy of this report was reviewed and provided to Administer, Kathleen Hyland.the state’s words, verbatim · CDSS document, Sep 4, 2025 · control 18-AS-20250411091834

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Sep 19, 2025

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature… This requirement was not met as evidence by: based on records review, (1) one out of (1) one resident was not free of punishment, humiliation, intimidation, abuse, and/or other actions of a punitive nature by staff taking away resident personal items.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Administrator Kathleen Hyland will have all managing staff conduct an out-service training on residents personal right. The outside training certification along with staff signatures will be forwarded to LPA via email by Close of Business on 9/19/2025.

Allegation investigated: Resident develop pressure injuries while in care. Resident sustained unexplained injuries.

Licensing Program Analyst (LPA) Debbie Palacios conducted an unannounced visit to the facility to initiate the investigation into the allegation listed above. LPA met with Office Manager Kailene Martinez and was informed of the purpose of the visit. During the visit, LPA toured the facility and conducted two (2) staff interviews. LPA requested resident records, resident roster, and staff roster for review. Information obtained from records reviewed revealed Resident # 1 (R1) is not a resident at the facility. LPA conducted an interview via telephone with Administrator Kathleen Hyland who reported R1 has never resided at the facility. Administrator reported that (R1) resided at The Legacy of Hemet 2 facility. LPA conducted an interview with staff #1 (S1) and reported that R1 has never resided at the facility. Unfounded This agency has investigated the complaint alleging resident develop pressure injuries while in care and resident sustained unexplained injuries. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 15, 2025 · control 18-AS-20250709082910

Type of visit: Required - 1 Year

On 02/20/25 Licensing Program Analyst (LPA) Debbie Palacios conducted a required one (1) year annual inspection visit. LPA was granted entry and met with Administrator, Kay Hyland and Maintenance Director Rick Jackson, who were informed of the purpose of the visit. The facility had 7 residents present at the time of the visit. The facility has three separate buildings. Building "A" is designated for residents in assisting living; Building "B" is designated for the Administrative offices. Building "C" has the kitchen and main centralized medication room. LPA toured the interior and exterior area of the facility. Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were in good repair and were present. Resident bedrooms had the required bedding and furniture, sufficient storage space, and lighting. LPA observed call light systems in the bedrooms. Each bedroom has a bathroom attached for residents. LPA observed bathroom appliances were operating in safe and sanitary conditions and were equipped with non-skid mats and grab bars. Facility kitchen had the ability to prepare food in a clean environment and possessed equipment and walk-in refrigerator and freezer in good working condition. LPA inspected storage areas where storage, cleaning supplies, and toxins are locked and inaccessible to residents. Administrator confirmed that fire alarms, fire extinguishers, and carbon monoxide detectors were serviced by the fire department. The facility has several large activity areas and dining area for residents where residents are able to watch television and be part of their daily activities. LPA reviewed the Medication Administration Record along with the physical medications for six (6) residents and did not discover any discrepancies. LPA reviewed six (6) resident files and observed residents had updated admission agreements. Staff files reviewed had the Department's required training records and valid first aid/CPR certification. Exit signs, emergency contact information, client's personal rights, and complaint information are visibly posted throughout the facility. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez conducted a required one (1) year annual inspection visit. LPA was granted entry and met with Administrator, Lisa Henderson, who was informed of the purpose of the visit. The facility does not have residents in care. The facility is currently under renovation. Licensee has chosen to maintain the license for the facility and plans on placing residents in the facility once renovations are complete. The facility has three separate buildings. Building "A" and building "B" are designated for residents in assisted living. Building "C" will be the administration building with a kitchen and main centralized medication room. LPA toured the interior and exterior area of the facility. The following was observed, reviewed, and inspected: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were in good repair and were present. Resident bedrooms had the required bedding and furniture, sufficient storage space, and lighting. LPA observed call light systems in the bedrooms. Each bedroom has a bathroom attached for residents. LPA observed bathroom appliances were operating in safe and sanitary conditions and were equipped with non-skid mats and grab bars. Facility kitchen had the ability to prepare food in a clean environment and possessed equipment and walk-in refrigerator and freezer in good working condition. LPA inspected storage areas where storage, cleaning supplies, and toxins would be locked and inaccessible to residents. Administrator confirmed that fire alarms, fire extinguishers, and carbon monoxide detectors were serviced by the fire department. The facility has several large activity areas and dining area for residents. Building "A" and building "B" each have their own kitchenette and medication room. Based on LPA's observation, the facility is not ready for resident placement due to currently being under renovation. Although there are no resident currently residing in the facility, renovations for the facility must be completed and in in compliance with Title 22 regulations prior to accepting residents. In addition, LPA advised the administrator that the facility must call the Community Care Licensing prior to accepting residents. An exit interview was conducted where a copy of this report was provided to Administrator, Lisa.the state’s words, verbatim · CDSS document, Feb 21, 2024