Mission of Love II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Jessica Villanueva, Administrator, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (14) and a current census of (11) residents in care. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pools or similar bodies of water. The facility has sufficient indoor and outdoor areas for resident activities. Outdoor shaded area is sufficient for resident activities and is enclosed with latching gates. The facility has sufficient lighting and is maintained at a comfortable temperature of 72 degrees fahrenheit (F). Resident bathrooms audited were operating in a safe and sanitary conditions. The hot water temperature in residents' bathrooms measured 106 degrees F. Resident bedrooms audited had sufficient lighting and furniture in good repair. Facility has smoke/carbon monoxide alarm system, fully charged fire extinguishers, covered fireplace, emergency water, laundry equipment, and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area: the Community Care Licensing complaint poster, Ombudsman poster, Resident Personal Rights, facility license and emergency telephone numbers. Facility staff maintains sharps, disinfectants, and cleaning solutions in a locked cabinet. Food Service: Facility kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. The facility has sufficient cups, plates, and utensils for residents to use. Care & Supervision: Facility has 24-hour, 7 days a week care staff. Medical Related Services: Facility staff maintains resident's medications and medications are centrally stored in a locked cabinet. The facility has first aid kits with a manual. Record Review: (5) staff files audited were observed to be complete. (5) resident files audited were observed to be complete. Facility staff maintains a resident registry, liability insurance, infection control plan, emergency disaster plan and staff disaster training for review. No deficiencies were cited during today's visit. An exit interview was conducted where this report was discussed and a copy was provided to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Caregivers, Christian Avila and Anita Oja and introduced self and stated purpose of the visit. LPA was informed that there are currently 10 residents in care who are in the facility. The facility has 7 resident bedrooms, 2 staff bedrooms, 3 bathrooms, kitchen, dining area, living room, laundry area, office area, 2 detached garages, and backyard. LPA completed a walk through of facility, and review of records. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 70 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 119.9 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, fire extinguisher and first aid kit. Posters such as; the personal rights, ombudsman, CCL complaint poster and license were posted in a common area. LPA also observed cleaning supplies, toxins, sharps, and other dangerous items locked in cabinets made inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed secured and inaccessible to residents. There are no bodies of water, guns or ammunition in the facility. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a wide variety of food available for residents. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, a side gate with self-latching handle on the left and right side of the house that leads into the backyard, and 2 detached garages used for storage. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed 5 resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed personnel and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA reviewed the facility's insurance coverage, emergency disaster plan, infection control plan and emergency drills. LPA observed that the Infection Control Plan was not reviewed/updated annually. Deficiency issued. LPA observed that the Emergency Disaster Plan was not reviewed/updated annually. Deficiency issued. LPA observed oxygen administration in the facility. LPA observed through interview that the licensee did not have a report sent to the local fire department for oxygen used in the facility. Deficiency issued. LPA observed that the licensee disconnected the fire alarm/sprinklers servicing. Deficiency issued. Deficiencies were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D and appeal rights were discussed and copies were provided to the Licensee, Jessica Villanueva who arrived during the facility tour.the state’s words, verbatim · CDSS document, Feb 7, 2025

Allegation investigated: Staff did not ensure that the facility remains free of odors Staff did not assist resident with incontinence needs Staff did not prevent resident from developing a pressure injury while in care Staff did not ensure an adequate quantity of food was served to resident in care

Licensing Program Analysts (LPAs) Anna Bueno and Bianca Wolcott conducted an unannounced visit to the facility for the purpose of initiating the investigation and delivering findings of the above allegations. LPAs met with licensee Jessica Villanueva who was advised of the purpose of today's visit. The investigation consisted of observations of the physical plant, review of records, and interviews with relevant parties. Allegation 1: Staff did not ensure that the facility remains free of odors LPAs and License toured the facility including all resident bedrooms and bathrooms and found the facility to be clean with absence of foul odors. LPAs observed facility staff bring soiled clothing and beddings to the laundry area thought the visit. Interviews with staff revealed that all residents are receiving laundry services as part of basic services. Additionally, there is no schedule for laundry services – it is done every day and as needed. Allegation 2: Staff did not assist Resident with incontinence needs. Interviews with staff reveal that most residents are incontinent and wear briefs. LPAs observed Resident with a fresh diaper. Through interviews, it was discovered Unsubstantiated discovered that staff check on residents about every two hours and soiled briefs are changed during checks or as needed, per residents request. LPAs observed staff assist residents with toileting. Allegation 3: Staff did not prevent Resident from developing a pressure injury while in care. Through interviews, LPAs were informed that resident was receiving hospice services when they sustained an injury. Witness interviewed revealed that Resident pressure injury was due to their combative behavior that has been addressed. LPAs observed Resident with pressure sore protection. Allegation 4: Staff did not ensure an adequate quantity of food was served to resident in care. LPAs were present during lunch services and observed staff offer seconds. LPAs observed staff assist residents who require food intake assistance. LPAs inspected kitchen refrigerators and pantry and found the facility stores more than two days of perishable and seven days on nonperishable food items. Additionally, LPAS observed protein shakes for supplementary/meal alternate. Based on the information revealed during the investigation, these allegations are therefore unsubstantiated. A finding of UNSUBSTANTIATED means, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with and a copy of this report was provided to Licensee.the state’s words, verbatim · CDSS document, Mar 4, 2024 · control 56-AS-20240228135949

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Anna Bueno annd Bianca Wolcott conducted an unannounced visit to the facility for the investigation of complaint number: 56-AS-20240228135949. LPAs met with licensee Jessica Villanueva who was advised of the purpose of today's visit During today's visit, LPAs interviewed relevant parties, made facility observations, and reviewed records. It was observed that Resident 1 was restrained to their bed with a sheet. Staff interviewed stated that the sheet is used for prevention of falling when Resident 1 is upright. The sheet covered Resident 1 through their top forearm and tied to the corner of a bed rail loosely. This pose as an immediate health and safety risk to resident in care. Refer to LIC 809D for deficiency cited. Resident 1 was immediately released from the restraint. LPAs did not observe any bruising or skin discoloration on Resident 1's forearms during the use of the sheet or any restraint. An exit interview was conducted where this report, LIC809-D, and appeal rights were discussed with and provided to Licensee.the state’s words, verbatim · CDSS document, Mar 4, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5) · Plan of correction due date: Mar 4, 2024

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. This requirement was not met as evidenced by: Resident 1 was observed tied to their rail with a sheet. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 4, 2024

Plan of correction: Licensee immediately removed the sheet or restraint during today's visit. Licensee verbally affirmed understaing of regulation cited for postural support as well as regulations pertaining to personal rights. This deficieny was satisfied during today's visit.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with care giver Anita Oja and was granted entry to the facility. The facility is a (9) bedroom (3) bathroom home and, with a kitchen/dining area, living room, unattached garage. LPA was accompanied by care giver Anita Oja to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated space for client/staff files. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (4) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (4) resident medications. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. During record reviewed, LPA did not observe the following items: Infection Control Plan, Emergency Disaster Planned and Planned Activities for the residents. Based on the observations made during today’s visit, three (3) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809)(LIC809D) was discussed and provided Care Giver Anita Oja. Along with a copy of the Appeal Rights.the state’s words, verbatim · CDSS document, Dec 19, 2023