Norwalk Villas II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elena Mallett conducted an annual inspection of the facility. LPA arrived unannounced and met with staff in charge Marselina De Leon. The purpose of today's visit was explained. Staff in charge contacted Administrator Cherie Wood by phone and Administrator joined the visit at 12PM. The facility is licensed to serve 6 elderly residents ages 60 and above, all can be non-ambulatory with one bedroom approved for bedridden. There are currently 6 residents in care. The facility is a single-story home located in a residential area in Norwalk, Ca. A tour of the facility includes: living room, kitchen, dining area, 4 bedrooms (2 double and 2 single), one resident bathroom and one staff bathroom and one staff bedroom,a front yard, a back yard,a detached garage and laundry room. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today’s visit and the initial visit and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan, Dementia Plan and training, and facility maintains the required current liability insurance. Physical Plant & Environment Safety: LPA toured facility. The facility is well maintained and walkways and hallways are free of debris and obstruction. Residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The required furnishings, light and bed linens were observed. A deficiency was observed. See 809-D. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products and extra towels and linens are available for residents. The hot water temperature in the resident bathroom faucet measured within Title 22 requirements of 105F-120F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept locked and are inaccessible to residents. Smoke detectors and carbon monoxide detector are interconnected and were tested observed to be operable. A fire extinguisher was present and was fully charged. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Appliances were observed to be operable and able to properly store and prepare food. Food was stored separate from toxins and poisons. A cabinet was observed not to be able to close properly. Administrator to repair cabinet door. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a locked closet and are in their original containers. LPA reviewed 6 residents’ medication logs and there were no issues observed. One resident's prescription supply was noted by LPA to soon run out and Administrator resolved the issue. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites and a plan to handle residents who have special needs. Emergency food and flash lights were present. A full First Aid kit and Manual were available. Facility runs quarterly disaster drills with the most current drill run on 06/26/26. Residents with Special Health Needs: Residents at this facility that require the use of bed rails have the required doctor’s approval. Oxygen in Use sign was present for room where oxygen is used. Documentation for residents receiving outside health services was present in files. Facility admits residents with dementia and staff have all required training documented within personnel files. Staffing: There appears to be sufficient staffing at all times in the facility. With night staff that is trained and able to assist in care and supervision of the residents in the case of an emergency. Personnel Records-Training: LPA reviewed 5 staff files. Files were reviewed for Criminal Record Clearance, Health Screening, Current First Aid and CPR as well as initial and ongoing training for care of the Elderly. No issues were observed. Administrator Cherie Wood's Administrator certificate is current until 08/19/2027. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 6 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility offers activities to residents like walks outside and to the store. Activity supplies like word puzzles, jigsaw puzzles and coloring books are available for residents. A central TV viewing area was observed that residents can enjoy together. Administrator to try some group exercise activities with the residents in the TV room. There is an outdoor, shaded furnished patio area available for the residents. Administrator to add a few more chairs to the existing set up to accommodate more residents at one time. There was a deficiency cited today per Title 22 regulations. An Exit interview was conducted with Administrator Cherie Wood and a copy of this Licensing report was provided along with Appeal Rights.the state’s words, verbatim · CDSS document, Jul 21, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required- 1 year visit. LPA was met by Richel Feria, the Caregiver and explained the purpose of the visit. The Administrator, Cherie Wood arrived shortly after and the LPA explained the purpose of the visit. Facility is licensed for residents the age range of 60 and over. Six (6) non-ambulatory of which one (1) may be bedridden in room #5. Hospice waiver for four (4) residents. There are (1) bedridden and (1) hospice residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an updated infection control plan dated 11/01/2024 in place. The facility staff and residents continue to practice hand washing and disinfecting the facility each shift. The facility has sufficient PPE supplies. Operational Requirements: Facility is licensed for residents the age range of 60 and over. Six (6) non-ambulatory of which one (1) may be bedridden in room #5. Hospice waiver for four (4) residents which is within the fire clearance requirement. LPA observed current Liability insurance in place. The facility has a dementia care plan to accept or retain residents with dementia. The fire drill was last conducted on 06/17/2025. Physical Plant/Environment Safety: A tour of the single-story facility included: four (4) resident bedrooms, one (1) staff bedroom, one (1) resident bathroom, living room, kitchen, laundry room, front yard, backyard, and attached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The front and backyard are well maintained. Physical Plant/Environment Safety: There is a shaded seating area for the residents located in the backyard. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested and measured at 119.1 degrees F, which is within the required 105 - 120 degrees F. Sharps are kept locked in a kitchen cabinet. Chemicals and cleaning supplies are kept locked under the kitchen sink. The bathroom was clean and had the required grab bars in the shower and near the toilet for non-ambulatory residents. The shower has non-skid material. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in the hallway. Smoke detectors were observed in each room and throughout the facility and are properly operating. A carbon monoxide detector was tested and properly operating. A fire extinguisher was observed at the kitchen and is fully charged. Staffing: The facility has sufficient staff to provide care and supervision to the residents. The staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Personnel Records-Training: LPA reviewed five (5) staff files that include: Personnel Record, Health clearance, TB Result, Criminal Background Clearance, Employee Rights, 1st Aid/CPR training, Medication Management and Staff Training. The RCFE administrator certificate expired on 08/19/2027. Resident Rights-Information: Resident personal rights, complaint hotline information and visitors’ policy posters are posted. Per Administrator, facility provides internet services to all residents and have access to the facility phone. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. LPA observed sufficient equipment and supplies to accommodate residents with special needs to meet the requirements of the activity program. Food Service: Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Sufficient food supply is stored in the kitchen consisting of 2-day perishables, 7-day non-perishables, and emergency food supplies. Pesticides and cleaning supplies are kept away from the food preparation areas. Per administrator, there are no residents that have a modified diet. Incident Medical and Dental: Medications were reviewed for six (6) residents to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are centrally stored and in their original containers. Medications are administered as prescribed by the Physician. Medications are bubbled packed. LPA reviewed six (6) residents medication files and observed the Centrally Stored Medication Destruction Record in file. The first Aid kit was observed and has all required items. Resident Records/Incident Reports: LPA reviewed five (5) resident files that include: the Face Sheet, Admission Agreements, Physician's Reports, TB Clearance, Ambulatory Status, Pre-Placement Appraisal, Functional Capability Assessment, Resident Appraisal, Physician’s Orders, Appraisal/Service and Needs Plan, and Personal Rights. Disaster Preparedness: Emergency and Disaster Plan LIC 610E dated 08/01/2025 is in place with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: There are no residents receiving home health services and one (1) resident receiving hospice care. The facility has a hospice care plan. There are no residents with prohibited health conditions. Based on record review, LPA observed that Resident #1 (R1’s) file did not have a written Physician’s Order for a half bed rail. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the as provided to Cherie Wood, Administrator.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Mora conducted an announced Pre-Licensing visit using the CARE Tool. LPA met with Cherie Wood (Administrator) and explained the reason for the visit. A change of ownership application was submitted to the Community Care Licensing Department (CCLD) for a Residential Care Facility for the Elderly (RCFE) to serve five (5) non-ambulatory and one (1) bedridden residents in the age range of 60 and over. A tour of the single-story facility included: 4 resident bedrooms, 1 staff bedroom, 1 resident bathroom, living room, kitchen, laundry room, front yard, backyard, and attached garage. LPA and Cherie toured the facility and the following was observed: sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested and measured at 110.1 degrees F which is within the required 105 - 120 degrees F. The bathroom was clean and had the required grab bars in the shower and near the toilet for non-ambulatory residents. The shower has non-skid material. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in the hallway. Smoke detectors were observed in each room and throughout the facility and are properly operating. A carbon monoxide was observed in the living and it is properly operating. A fire extinguisher was observed in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept locked in a kitchen cabinet. Chemicals and cleaning supplies are kept locked under the kitchen sink. First Aid kit was fully stocked with current manual and it is kept locked in the medication closet. The front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction. Residents medication are centrally stored in a locked living room closet. Residents and staff files are centrally stored in the medication closet. LPA reviewed medication for 5 residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for 5 residents and 3 staff. LPA observed a RCFE administrator certificate for Cherie Wood with an expiration date of 08/19/2025. (Continued to LIC 809-C) No outstanding or pending items were observed by the LPA requiring additional pre-licensing visits. LPA will notify the assigned Centralized Applications Bureau (CAB) Analyst of the completed pre-licensing facility evaluation visit conducted, which included the Component III Orientation. Exit interview conducted and a copy of this report was provided to the licensee.the state’s words, verbatim · CDSS document, Aug 19, 2024