Norwalk Villas I

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Cherie Wood, administrator for the facility, and explained the purpose of the visit. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. The facility consists of four (4) resident bedrooms, an office, a caregiver room, a kitchen, dining room, a living room, and an attached garage that contains the washer and dryer for the facility. The facility contains three (3) bathrooms including checking their water temperature, which all fell within the required range of 105 – 120 degrees Fahrenheit. The carbon monoxide detector is operational in the home. A fully charged fire extinguisher is kept on the premises. Operational Requirements: · Fire clearance was approved by LA County Fire Department for a capacity of six (6) non-ambulatory residents, and a hospice waiver approved for six (6) residents. · During record review of the residents’ files, it was determined that five (5) residents are listed as non-ambulatory, however the maximum number of residents that may be non-ambulatory in the facility is four (4), which exceeds its limit. Resident #1 (R1) is listed as non-ambulatory based on their physician's report, however administrator stated they are ambulatory. Administrator explained that she will work towards obtaining an updated physician report for R1. · Care and supervision to meet the clients’ needs was observed. Staffing: · Eleven (11) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · All five (5) staff records have a health screening with a Tuberculosis clearance, First Aid/CPR trainings that are active, and required annual training. · Administrator’s certificate expires on 8/19/2027. Resident Rights/Information: · Physician orders were reviewed for six (6) resident files. · Medications were also reviewed for six (6) residents. Resident Records/Incident Reports: · Six (6) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have are assisted with medication management by staff. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility and LPA obtained a copy. · The last emergency and disaster drill was conducted on 6/25/2026. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. · Documentation was shown that a home health agency provides care for Resident #3’s colostomy care. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit is documented on the LIC809D page. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 24, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Cherie Wood, administrator for the facility, and explained the purpose of the visit. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. The facility consists of four (4) resident bedrooms, one (1) staff room, a kitchen, dining room, a living room, and an attached garage that extra supplies for the facility, and a laundry room as well.The facility contains three (3) bathrooms including checking their water temperature, which all fell within the required range of 105 – 120 degrees Fahrenheit. The carbon monoxide detector is operational in the home. A fully charged fire extinguisher is kept on the premises. Resident Rights/Information: · Physician orders were reviewed for six (6) resident files. · Medications were also reviewed for six (6) residents. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have are assisted with medication management by staff. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility and LPA obtained a copy. · The last emergency and disaster drill was conducted on 6/25/2026. Due to time constraints, the annual inspection will be completed at a later date. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 21, 2026

Allegation investigated: Staff inappropriately touched resident Staff are not following doctor's orders for resident Staff are not providing adequate food service to resident Staff make resident feel uncomfortable Staff are not providing a safe environment for resident

Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Staff S1. Administrator Cherie Wood arrived shortly after and the reason for the visit was explained. The investigation consisted of the following: LPA Trueman obtained copies of the Staff roster, Resident Roster, and Special Incident Report (SIR). Resident R1's file was reviewed copies of Physician's Report, MAR's Log, Physician's Order, Centrally Stored Medication Log and Emergency ID Face Sheet to be submitted. Tour of the facility was conducted which included the kitchen and observation of the food supply Interviews were conducted with Administrator, Staff S1 and Staff S2. Resident R1- R4 was interviewed. Social Worker for Resident R1 was interviewed. Medication was reviewed for Resident R1. In regards to the allegation Staff inappropriately touched resident, based on interviews conducted and information gathered, Resident R1 who stated that he doesn't know if the touch was appropriate or Unsubstantiated inappropriate. Social Worker for Resident R1 stated that she does not think there is any evil intent to touching having occurred. Stated that staff are very nice and there have been no issues at all. Resident's R2-R4 stated that staff has never touched them inappropriately and never seen them touch R1 inappropriately. Said they have had blood pressure checked and it has always been appropriate. All said staff are great and the house is peaceful till R1 arrived. 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, therefore the allegations are Unsubstantiated. In regards to the allegation Staff are not following doctor's orders for resident, based on interviews conducted and information gathered Resident R1 revealed that the doctor prescribed new meds and he never heard the doctor say don't take meds. Resident's R2-R4 stated they always have received their medication and staff has always done a good job. Said they heard R1 stating he doesn't want to take medication because of the side affects. Staff S1, S2 and the Administrator stated that R1 has been receiving medication daily and they initial each day on the MAR's Log. Review of medication for R1 for November show all doses administered as prescribed. Physician's Order dated 10/25/25 was observed by the LPA which included 4 medications. 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, therefore the allegations are Unsubstantiated. In regards to the allegation Staff are not providing adequate food service to resident based on interviews conducted and information gathered Resident R1 stated that the hair could have been from his blanket or cap. Said not sure. Social Worker for Resident R1 stated that not sure about the hair, but it is consistent with R1's behavior. R3 stated to be here 1 and 1/2 years and never has there been a hair in their food. Said they all wear hair nets and it easily could have been R1's hair. R2 and R4 also stated staff always wear hair nets and they have never had hair in their food. Administrator and Staff S1-S2 stated they always wear hair nets 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, therefore the allegations are Unsubstantiated. In regards to the allegation Staff make resident feel uncomfortable, based on interviews conducted and information gathered Social Worker for Resident R1 stated that there has been no issues with this facility. Stated staff are nice and residents are not aggressive. Said there have been no visits from outside agencies until now. Stated that there are other residents that are in the home and they have always said the home is very peaceful, comfortable and like a family. Spoke with Administrator, Staff S1 and S2 who all stated the residents are always taken care of. It is always peaceful and they are like a family. Said they are nice to R1 and assist like they do for all with medication and food. Always try to make residents comfortable. Resident R2-R4 said staff always have made them feel comfortable and said they have done the same treatment for R1. 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, therefore the allegations are Unsubstantiated. In regards to the allegation Staff are not providing a safe environment for resident, based on interviews conducted and information gathered Resident's R2- R4 all stated that R1 was the one who tried to attack staff and also them. All said it is R1 who has made the place unsafe. All stated that Staff S1 came to check on residents outside and then R1 chased staff in. R3 stated he went to stick up for Staff S1 and R1was then yelling and screaming. Social Worker for R1 stated the staff and residents are very nice and there has been no issues until now. Administrator stated it is a very safe environment and there are no aggressive residents. Said it is not unsafe and can freely walk all over. Staff S1 and S2 stated that it is very safe and all have been here a long time. If residents are outside the house they will check on their safety. 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, therefore the allegations are Unsubstantiated. Exit interview conducted and report provided to Administrator.the state’s words, verbatim · CDSS document, Nov 4, 2025 · control 28-AS-20251103093435

Allegation investigated: Staff does not ensure client is spoken to in an appropriate manner. Staff did not prevent client from threatening other client in care

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with staff Liberty Palcone. Administrator arrived shortly after and assist with the visit. The reason for the visit was explained. The investigation consisted of the following: LPA Margaryan obtained a copies of the Staff roster, Residents roster, reviewed Client 1 (C1) file and obtained copies of relevant documents. Interviews conducted with Administrator, Staff 1 and Staff 2 (S1 and S2), Client1 to Client 4 (C1 to C4). S1 was interviewed over the phone. Continue 9099C Unsubstantiated The investigation revealed the following: Regarding allegations: Staff does not ensure client is spoken to in an appropriate manner. It was alleged that Staff (name unknown) yelled at the client and called them an “angry person” when client told staff not to interrupt their video that client was filming outside. Interviewed Administrator and staff denied the allegation. They stated that they do not yell at clients and have not observed that other staff yell at clients. They stated that they didn't call C1 or other clients “angry person”. Interviewed Administrator stated that on 10/14/25 there was an incident that C1 was making a video in front of facility. During one of staff round, responsible for monitoring clients outside the facility, the staff (S1) didn't notice that C1 filming a video and walked into the area where the filming was taking place. C1 started to yell on S1, stating that S1 disrupted the video that C1 was making. Despite S1's apology to C1, continued to verbally confront S1. Upon entering the facility C1 continued to yell at the staff. One of the clients (C2) came out from their room and asked C1 to stop yelling towards the staff. Staff make sure that C2 is safe and back in their room. After a while C1 calmed down and went in their room. Interviewed S1 stated that incident happened between them and C1 on 10/14/25. S1 went outside of the house and didn't know that C1 was filming. S1 steeped out to check on clients who were outside of house. S1 stated that C1 raised their voice and yelled on S1, stating that S1 disturbed C1. S1 said sorry to C1 but C1 didn't stop yelling. C1 continued to yell on S1 after entering the house. Interviewed S2 stated that they heard how C1 was yelling on S1. S2 stated that S1 didn't yelled back and try to calm C1 down. Interviewed staff stated that staff didn't yell and called “angry person” C1 or other clients. Interviewed clients stated that facility staff is nice and treat them with respect. Interviewed C2 and C3 stated that C1 always yelling and always complains about everything and about everyone. C2 stated that about week ago C1 was screaming, yelling and threatening S1. C2 who was sleeping in their room, came out and ask C1 to stop yelling and threatening the staff. Interviewed C1 stated that staff are nice and this place is 100% better comparing with previous facility that they lived before. C1 stated that they feel safe here. Continue 9099C Regarding allegation: Staff did not prevent client from threatening other client in care. It was alleged that client (name unknown) threatened C1 by getting in the client’s face and threatening C1 that they will be hurt if “they talk to staff that way”. Interviewed Administrator and staff stated that no one has threatened C1. They stated it was C1 who was verbally abusive and threatened staff and clients. Administrator and staff stated that on 10/14/25 C1 was yelling and threatening S1. During the round, S1 who was responsible for monitoring residents outside the facility, didn’t notice that C1 filming a video and walked into the area where the filming was taking place. C1 started to yell on S1, stating that S1 disrupted the video that C1 was making. Despite S1's apology to C1, C1 continued to verbally confront S1. Upon entering the facility C1 continued to yell at the staff. One of the clients (C2) came out from their room and asked C1 to stop yelling towards the staff. Staff make sure that C1 and C2 are safe and back in their rooms to avoid any issues. Interviewed S1 and S2 stated that C2 did not threaten C1. C2 just ask C1 to stop yelling and threaten the staff. Interviewed Administrator and staff stated C2 or other clients didn't get on C1's face and threatened C1 to hurt them. Interviewed C2, C3 and C4 stated that they never witnessed staff or clients threatening C1 that they would hurt C1. Interviewed C2 and C3 stated that C1 was threatened S1 about week ago. They stated that C1 was yelling at S1 and when C2 came out from their room and ask to stop, C1 started to yelled on C2 and was threatening C2 that will "break every bone in their body". C2, C3 and C4 indicated that C1 who often screamed, yelled and threatened staff and clients. Interviewed C1 stated that clients didn't threaten to hurt C1 and they are C1's friends and they are nice. Based on interviews conducted with facility staff, and facility clients, there was not enough supportive evidence to concur with the reported allegations. 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, therefore the allegations are Unsubstantiated. Exit interview conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 28-AS-20251014113314

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Cherie Wood and explained the reason for the visit. The facility is licensed to serve 6 residents age 60 and over of which 2 may be non-ambulatory and 2 may be bedridden in room #5 with a hospice waiver for 4. The facility is located in a residential area and consist of a single home with (4) resident bedrooms, (3) bathrooms, (1) staff bedroom, a living room, a dining room, a kitchen, a laundry area, an attached garage a front yard, and a back yard. The following domains were reviewed during this visit: Infection Control: Facility maintains a copy of the infection control plan. All staff have a TB clearance. Operational Requirements: Facility maintains a plan of operation, fire clearance. Facility is operating within the limitations of their license. They currently don't any residents under hospice care, home health, or bedridden. A current liability insurance was observed and a copy was obtained. Physical Plant/Environmental Safety: LPA toured the facility with Cherie Wood and observed the following. Facility was observed in good repair. Living room and dining room were observed with furniture and in good repair. Kitchen was observed clean. Cleaning supplies and sharps are maintained in a locked drawer, sharps magnetic lock was observed slightly out of place. Refrigerator/freezer and pantry were observed. Medication cabinet is located across from the kitchen. Four (4) resident rooms were observed with sufficient lighting, required furniture and bedding supplies. Half bed rails were observed in Resident #1,2,3, and 5 beds, here is no physician's request on file. Three (3) bathrooms were observed in good repair and clean. Water temperature was tested in each bathroom sink and tested between 109.0-113.3 degrees F., which is within the required 105-120 degrees F. A fire extinguisher was observed. Carbon Monoxide/Smoke detectors were tested and are in working condition. (CONTINUED ON LIC 809C) Laundry area was observed in good repair. Facility maintains linens. No large bodies of water were observed. Passageways were clear of obstructions. Staffing: Administrator certificate was reviewed for Cherie Wood #7010587740 exp. date: 8/19/27. CPR/First aid training was observed for staff. Staff is on duty during the night shift. Personnel Records/Staff Training: LPA reviewed 5 staff files. Files were available for review. Files include; TB clearance, health screening, background clearance, personnel record, and training for each staff. Two staff were interviewed. Resident Rights/Information: License, Let us Know (PUB 475), Ombudsman, personal rights posters were posted in home's common area. Planned Activities: Facility provides activities such as puzzles, books. Food Services: LPA observed at least 2 days of perishables and 7 days of non- perishable food supplies. An additional refrigerator was observed in the garage. Kitchen was observed clean and free of pest. Three residents have a modified diet per medical assessments. Incidental Medical and Dental: Facility provides assistance with medical/dental arrangements and with medication assistance. Medications were observed stored in locked medication closet. LPA reviewed medication for 5 residents. Resident Records/Incident Reports: LPA reviewed 5 residents files, each contained admission agreement, medical assessment, TB clearance, pre-appraisal, and appraisal. Two resident were interviewed. Disaster Preparedness: LPA reviewed emergency disaster plan LIC 610E(3/19) last reviewed on 8/1/25. Emergency drills are conducted quarterly, last emergency drill was conducted on 8/1/25. Emergency food supplies were observed. Residents with Special Health Needs: Facility is not serving residents with Special Health Needs. Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Cherie Wood and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 25, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Nune Margaryan and Cota Mayra conducted an announced pre-licensing visit using CARE Tool. LPAs met with Administrator Cherie Wood and explained the reason for the visit. This Pre-Licensing Inspection is due to a change of ownership. The facility has an approved fire clearance for two (2) non-ambulatory residents, two (2) ambulatory and two (2) bedridden resident. Facility approved for total capacity of (6) six. The facility is a single-story home, located in a residential area, that consists of a living room, dining area, (4) resident bedrooms, (2) bathrooms, a kitchen, staff room, attached garage, and shaded patio with seating in the back yard. Laundry area observed in the hallway. A locked storage area for central storage of medications was observed in the dining area. All cleaning solutions and disinfectants was observed locked in the garage. Fire extinguisher was observed in the kitchen, and it is fully charged. Carbon monoxide / Smoke detectors were observed throughout the facility and were tested and operable. Doors, exits, hallways, and passageways were clear and free of obstruction. The front and back yards were observed to be clean and free of debris. No pools or bodies of water were observed in or around the home. Grab bars and non-skid mats were observed in the bathrooms. There are no firearms present at the facility. The first-aid kit was observed and is kept in the medication cabinet which included all required supplies. Appliances such as a microwave, refrigerator and stove were observed to be clean and operating properly. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Additional food supplies observed in the garage. Sharps and cleaning solutions are kept locked in a kitchen cabinet and in the garage. Continue 809C The water temperature was tested in both bathrooms and measured at 107.2 degrees F and 108.1 degrees F, which is within the required 105-120 degrees F. Residents bedrooms have all required furniture, lighting, and bedding. There is closet space for clothing and other belongings. Extra clean linen was observed in the closed located in the living room. Staff and client files are maintained locked in a cabinet located in the dining room area. LPA conducted the Component III with Administrator. The Pre-licensing is complete, and the facility has no deficiencies. Exit interview conducted and a copy of this report was provided to Administrator. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Aug 27, 2024

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, May 21, 2024