Palm Valley Care I

Type of visit: Required - 1 Year

Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 08/10/26. LPA identified herself to the Caregiver on duty, explained the purpose of the visit, and asked to speak with Licensee/Administrator. Angelita Dayoan arrived shortly after. LPA noted the Administrator's certificate, # 7010652740 expired on 01/04/27. The facility was approved for 6 non-ambulatory and a hospice waiver for 5. The inspection began in the kitchen. All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. Opened packages in the refrigerator were dated appropriately. LPA inspected resident bedrooms and 1 staff room. All resident rooms had the required furniture, furnishings and lighting to be in compliance at this time. All common areas were also in compliance at this time. LPA noted soap, paper towels and trash cans in the bathrooms. LPA provided technical assistance regarding lids for the trash cans. The fire extinguisher was last serviced on 05/28/26 by Cintas and was also in compliance. The LPA observed medications were stored, locked, and inaccessible to residents in care. LPA reviewed storage, dosing, and follow-up after administering PRNs. A review of the First Aid kit by the LPA found it to be complete and in compliance. The exterior of the building was inspected by the LPA. There was a pool surrounded by a fence with a locked gate. LPA observed that gutters were in good repair but there were screens that needed to be repaired or replaced due to holes or not fitting properly. LPA documented this as a technical violation. The LIC 500 was compared to the Guardian roster to ensure that all staff had their proper clearances. LPA reviewed 2 staff and 2 resident files. All were also in compliance. According to the California Code of Regulations, Title 22, no deficiencies were cited during today's visit. A copy of this report was provided and an exit interview was conducted with the Administrator.the state’s words, verbatim · CDSS document, Aug 10, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On April 30, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct a case management visit. LPA initially met with staff on duty, and stated the purpose of the visit. The administrator, Angelita Dayoan, was notified and arrived shortly after. The purpose of the visit is to issue citation based on an office meeting with the Department of Labor (DOL) conducted on April 6, 2026. Documentation from DOL shows that Angelita Dayoan and Nicholas Padua, both responsible parties of the restitution, did not comply with the DOL restitution agreement requiring payment of back wages to former employee, S1. DOL reported that despite having S1’s correct and current address, Angelita admitted she made no attempts to pay the required restitution. Email correspondence with from DOL representative to Angelita dated April 6, 2026, indicated S1’s address was verified as current and specifying the required payment amount of $13,125.00, consisting of wages and accumulated interest. Furthermore, DOL’s communication with S1, which S1 stated that no one from the facility attempted to contact or pay S1. DOL reported that Angelita confirmed she made no payment attempts. Based on the information gathered, deficiencies are being cited today. Exit interview was conducted with Angelita and Plan of Correction (POC) was discussed. Prior to this visit, Angelita stated she mailed the payment to S1 on April 15, 2026, and that she will submit all required documents to DOL by May 4 2026. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 30, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(2) · Plan of correction due date: May 1, 2026

Administrator – Qualification and Duties: The administrator shall have the qualifications… Knowledge of and ability to conform to the applicable laws, rules and regulations This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the regulation cited above. The licensee did not meet the terms of the federal wage settlement agreement. This poses a potential health, safety, and/or personnal rights risks to residents in care.the state’s words, verbatim · CDSS document, Apr 30, 2026

Plan of correction: Corrected prior to this visit. Angelita issued the full restitution payment via mailed check to S1 on April 15, 2026 and provided the documented proof during this visit

Type of visit: Office

An office meeting was conducted today, April 6, 2026, at 10:00am via Teams Meeting with the following individuals: Liza King, Licensing Program Manager (acting Regional Manager) Stephen Richardson, Licensing Program Manager Lisa Rios, Licensing Program Manager Arvin Villanueva, Licensing Program Analyst Patricia Canites, Department of Labor representative Kevin Navarro, Department of Labor representative Angelita Dayoan, Licensee/Administrator Nicholas Padua, Licensee The purpose of this meeting was to discuss the current status of the settlement payment with the licensees Angelita Dayoan and Nicholas Padua. This meeting followed up on a signed agreement for the licensees to repay back wages to employees via a payment plan. Angelita confirmed that several employees have received partial payments and that she is close to completing all payments. Providing proof of payment to Department of Labor (DOL) was delayed because the administrative contact, James, was unable to reach Angelita. Angelita reported having difficulties locating two employees: S1 and S2. DOL will assist in locating these individuals. Angelita was advised to attempt to contact S1 and S2. {1 of 2} Angelita was advised the final deadline to provide all proof of payment (cancelled checks) is May 4th 2026. Angelita agreed to upload all existing cancelled checks to DOL’s portal by tomorrow, April 7th 2026 no later than 5:00pm. Angelita confirmed that payments to employees are “free and clear” and that she has not requested the funds back from the employees. Due to communication issues and payment delays, licensees were advised that the Department will initiate an audit of this facility and other facilities that are under the licensees. This audit is to verify the facilities’ financial solvency and their ability to continue to operate. The licensees agreed to do the following: Upload all available cancelled checks to the DOL’s portal by April 7th 2026 no later than 5:00pm. Provide all remaining proof of payment by May 4th 2026. Licensees agreed to contact S1 and S2 first and provide back wages payment. If unable to locate or reach out to these individuals, licensees were advised to send payment to DOL. S1 and S2 will need to retrieve payments at DOL. The Department will do the following: The Department will conduct an audit to verify the facility’s financial solvency and their ability to continue to operate. No deficiencies were cited during today’s meeting. Exit interviews and licensees were informed that a copy of this report will be emailed to them and a request made by this LPA for licensees to sign the documents and send back a copy of the signed report. {2 of 2}the state’s words, verbatim · CDSS document, Apr 6, 2026

Allegation investigated: Staff are verbally and physically abusing residents. Staff leave residents on floor for an extended period of time. Staff do not ensure residents are provided quaility food.

On 9/23/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility to conduct a follow-up complaint visit and deliver findings regarding the allegations noted above. LPA initially met with staff on duty (S2) and stated the purpose of the visit. The Administrator, Angelita Dayoan, was notified and stated she is unable to be at the facility at this time and that her assistant administrator, Merceditas Galito (S3) will assist with the visit. S3 arrived shortly after. During this visit, LPA conducted additional interviews and record reviews. During this visit, LPA was informed that 2 residents had previously passed away. {pg.1} Unsubstantiated Allegation – staff are verbally and physically abusing residents: During the investigation, LPA reviewed the facility’s records, including staff training documents, resident care plans, and incident reports. LPA interviewed residents, staff members, and facility management. Resident interviews did not confirm any instances of verbal or physical abuse. Most residents mentioned that staff were kind and respectful, and they had not observed or experienced any form of abuse from staff. Staff members also stated that they were trained to handle residents with care and follow proper procedures when assisting them. Staff also mentioned that they have one resident who can never be satisfied, despite providing everything they asked for. Furthermore, there were no documented incidents of abuse in the facility’s records and there were no reports that matched the allegations of verbal or physical abuse. After gathering all available information, there is insufficient evidence to support the claim that staff members were verbally or physically abusing residents. Based on the interviews, records, and observations, the allegation of verbal and physical abuse is unsubstantiated. *************************************************************************************** Allegation – staff leave residents on floor for an extended period of time: As part of the investigation, residents currently living at the facility were interviewed. Residents stated that they receive help from staff when they ask for it. None of the residents confirmed that staff leave them on the floor or ignore them when they need assistance. Residents shared that staff respond to their needs and treat them with care and respect. Facility staff were also interviewed. Staff denied any form of abuse or neglect happening in the facility. One staff member stated that they always provide residents with what they ask for and make sure their needs are met in a timely way. In addition to the interviews, LPA reviewed copies of residents’ admission agreements. Under the “Personal Services” section, the agreement outlines that the facility will provide continuous care and supervision, monitor changes in condition, assist with medical and dental needs, and provide bedside care when needed for minor illness or recovery. Facility records and staff interviews confirmed that there is staff on duty during the night shift, from 7pm to 7am, to provide care and supervision to residents during the night. {pg.2} Based on the information gathered during interviews and document review, there is not enough evidence to support the claim that staff leave residents on the floor for extended periods of time. Therefore, the allegation is unsubstantiated. ***************************************************************************************** Allegation – staff do not ensure residents are provided quality food: As part of the investigation, residents were interviewed. Residents stated that they receive enough food and did not express concerns about the quality of meals. None of the residents confirmed the allegation that food being served is not good or not provided. Interviews with staff also did not confirm the allegation. Staff members explained that food is always given to residents and that staff provide what residents ask for. Staff reported that meals are prepared daily and follow a regular meal schedule. LPA reviewed the facility’s menu, which is structured on a 2-week rotating schedule. The menu includes a variety of meals for breakfast, lunch, and dinner, and offers different types of proteins (such as sausage, chicken, turkey, ham, and fish), starches (like rice, potatoes, macaroni, waffles, and pancakes), as well as vegetables and fruits. The meals appear to be balanced and follow appropriate food groups. Fruits are mostly served with breakfast and lunch, and many dinners include a protein, a starch, and a vegetable. LPA also reviewed the residents’ signed admission agreements. Under the “Food Services” section, the agreement states that residents will be provided with three nutritious meals and three snacks each day. It also mentions that special diets will be provided if ordered by a doctor. Lastly, during site visits on 5/8/25 and 6/18/25, LPAs Arvin Villanueva and Sommer Hayes observed the facility’s kitchen, refrigerators, freezers, and pantry. There was an adequate supply of food, including at least two days’ worth of perishable food and seven days’ worth of non-perishable food. A variety of items were present, such as fresh and frozen meats, vegetables, fruits, and canned goods. Based on interviews, document review, and observations, there is not enough evidence to support the claim that staff fail to provide residents with quality food. Therefore, the allegation is unsubstantiated. Note that a finding that is unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it. Based on today’s visit, no deficiencies were cited. Exit interview was conducted with S3 and a copy of this report and appeal rights were provided. {pg.3}the state’s words, verbatim · CDSS document, Sep 23, 2025 · control 27-AS-20250430122806

Type of visit: Required - 1 Year

On 6/18/2025 Licensing Program Analysts Sommer Hayes and Arvin Villanueva (LPAs) arrived at this facility unannounced to conduct an annual inspection. LPA initially met with staff on duty, and stated the purpose of the visit. The Licensee/Administrator, Angelita Dayoan (AD), was notified of the visit and arrived shortly after. Present during this visit were 6 residents in care with 2 staff on duty. During this visit, LPA observed one resident at the dining table having a meal. One resident in the living room watching TV with their visitor. Other residents were in their bedrooms. One outside agency staff arrived during the visit. LPAs evaluated the physical plant with AD to ensure the health and safety of the residents in care. The facility is a one-story home located in a residential neighborhood. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPAs observed common areas to be clean and free from debris and obstructions. All 6 resident bedrooms were observed to be fully furnished and have enough space to accommodate resident belongings. Three bathrooms were observed to be well maintained and sanitized. Facility maintains an adequate amount of linen supplies. The room temperature was observed at 75 degrees Fahrenheit upon arrival. Hot water temperature was taken in 2 resident bathrooms and were measured between 127 and 133 degrees Fahrenheit. In the kitchen area, the LPAs observed a small live cockroach inside one of the sliding drawers. Additionally, during an inspection of the kitchen freezer, two dead cockroaches were found at the bottom. In an interview, the AD stated that pest control services are used. AD provided pest control service agreement from November 2023 to October 2024; however, AD was unable to provide continuing pest control contract or any supporting documentation as proof of services being done after October 2024. One of the kitchen cabinet door was observed to be falling off when this LPA opened the door. During this visit, a person came to fix the cabinet door. Inside the refrigerator, LPAs observed a locked black metal container. {Con't to LIC809-C} The facility maintains nonperishable foods for a minimum of 7 days and perishable food for 2 days. Pantry was also observed to have adequate food supplies. Inside the pantry, LPAs observed a container which read CBD gummies on the top shelves. Per interview with staff on duty, that belongs to one of the staff. Staff on duty immediately took the CBD gummies. The garage houses additional freezers and refrigerators. Additional food supplies were observed in the garage. In one of the cabinet that is unlocked, contained food supplies and at the bottom shelf of the cabinet, LPAs observed chemicals including paint containers and Flex Seal aerosol spray bottle. Staff on duty immediately removed the items and placed them inside a locked cabinet. Fire extinguishers are maintained in the facility and were observed to be fully charged and were last serviced on 5/6/25. Medications, cleaning supplies, and sharp objects were observed to be locked and inaccessible to residents in care, except those found inside the garage cabinet. Smoke detectors were observed to be in each bedrooms and hallways and at least one carbon monoxide detector was observed. Outdoor area was inspected. Facility has 1 side gate exits. Facility has a swimming pool which was observed to be gated, locked with padlock and not accessible to residents in care. Gate and fences were observed to be in good repair at this time. LPAs observed one window screen and one sliding door screen to be in disrepair. Advisory was provided to AD to make necessary repairs. Review of 6 resident files (R1, R2, R3 R4, R5, R6) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Each resident binder had PRN authorization letter on file. A medication review for two residents was conducted by the LPAs and the AD, which included an assessment of physician orders for over-the-counter medications. During the review of Resident R5's medications, the LPAs identified three medications that did not comply with the physician’s orders. The medication Docusate (Stool Softener) was prescribed at 250 mg, but the facility only had 100 mg capsules available. According to interviews with the AD and staff, they administer two capsules, which still results in a 50 mg shortfall. Additionally, Turmeric was prescribed at 450 mg, but the facility had 500 mg capsules. Krill oil was ordered at 500 mg, while only 400 mg capsules were on hand. Furthermore, one of R5's medications, Metformin, was found to be expired. {Con't to LIC 809-C} Review of 3 staff files (S1, S2, and S3) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. No issues were noted at this time. Facility conducts quarterly disaster drill. Facility has a dementia and infection control plan. Administrator to submit copy of current Liability Insurance Certificate, LIC500 and LIC308 to the Department. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed during today's visit. The following deficiencies were observed during this visit: Cockroaches we observed inside a sliding drawer and inside the kitchen freezer. Hot water temperature in 2 resident bathroom faucets were between 127 and 133 degrees Fahrenheit. Container of CBD Gummies belonging to staff was observed inside the food pantry. 3 medications were not in compliance with doctor's orders. One resident medication was observed to be expired. Chemicals was being stored with food supplies inside a cabinet in the garage. Exit interview was conducted and a copy of the report was provided upon exit. Per California Code of Regulations, Title 22, Division 6, Chapter 6, deficiencies were observed during this visit. An exit interview was held, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 18, 2025

The state marks this report as 10 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Staff do not have adequate staffing.

On 5/8/2025, Licensing Program Analysts Sommer Hayes and Arvin Villanueva (LPAs) arrived unannounced at this facility to conduct the initial complaint visit regarding the allegations noted above. During this visit, LPAs were met by staff on duty (S1) and stated the purpose of the visit. The Administrator Angelita Dayoan (AD) was notified and arrived shortly after. Present upon arrival was 6 residents with 1 staff on duty (S1). During this visit, LPA conducted facility observation of food supplies including the refrigerator and freezer inside the garage, the refriegerator and freezer in the kitchen, and pantry. Duirng the inspection of the kitchen refrigerator, LPAs observed a medication (M1) inside the refrigeragor that is unlocked and accessible to residents in care. While inspecting the kitchen, LPAs observed the medication cabinet to be unlocked and accessible to residents in care. LPAs only observed S1 to be present upon arrival and was observed to be interacting with a resident in the TV area. Interview with S1 confirmed she is not a staff. {1 of 2} Substantiated Interview with AD revealed that S1 is in training and is not currently associated to this facility and has no background clearance to work at this facility. Review of Guardian confirms S1 is not associated to this facility. Interview with AD confirmed that the other staff (S2) went out of the facility and the other staff (S3) was at a personal appointment. Upon arrival to this facility , there was no staff on duty except for S1 who was not cleared to work at this facility. Therefore the allegation that staff do not have adequate staffing has been SUBSTANTIATED. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are cited on the 9099D during this visit. Licensee was provided a copy of their rights (LIC9058) and their signature acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided. {2 OF 2}the state’s words, verbatim · CDSS document, May 8, 2025 · control 27-AS-20250430122806

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: May 9, 2025

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced b: Based on interview and record review, the licensee did not comply with the regulation cited above. Upon arrival at the facility, there were no qualified staff members on duty, except for one individual who was not authorized to work at this location. This poses an immediate health, safety and personal risks to persons in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: Per discussion, the Licensee will ensure qualified staff are present at the facility at all times. Per discussion, the Adminsitrator agreed to submit a statement of understanding of the regulation cited relating to personnel requirments. Submit statement by POC due date.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 5/8/2025, Licensing Program Analysts Sommer Hayes and Arvin Villanueva (LPAs) arrived unannounced at this facility to conduct a case management visit. During this visit, LPAs were initially met by staff on duty (S1) and stated the purpose of the visit. The Administrator Angelita Dayoan (AD) was notified and arrived shortly after. Present upon arrival was 6 residents with 1 staff on duty (S1). During a complaint visit on 5/8/2025 (Complaint Control #27-AS-20250430122806), LPAs made the following observations: While inspecting the kitchen area, they found the medication cabinet unlocked, making medications accessible to residents in care. Furthermore, during an inspection of the kitchen refrigerator, LPAs discovered a medication (M1) inside the left door, also accessible to residents in care. Additionally, at the beginning of this visit, there was no qualified staff on duty, except for a staff that is not currently cleared or associated to work at this facility. The AD and other staff arrived later on. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are cited on the 9099D during this visit. Licensee was provided a copy of their rights (LIC9058) and their signature acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 8, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: May 9, 2025

(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the regulation noted above. During inspection of the kitchen, visiting LPAs observed the medication cabinet to be unlocked and medications were accessible to residents in care which poses an inmeediate health, safety, and pesonal risks to persons in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: Per discussion, Administrator will submit a statement of understading of the regulation cited relating to proper storage of medication. Submit statement by POC due date.

Type of visit: Required - 1 Year

On 6/5/24 at 10am, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. LPA initially met with a staff on duty and explained the purpose of today’s visit. The facility administrator, Angelita Dayoan, was informed of the visit and arrived shortly after. The facility is currently licensed to serve 6 non-ambulatory elderly residents The facility is approved for 5 hospice residents. Present during this visit, there were 6 residents in care with 2 staff on duty. At 10:30am LPA and Administrator inspected the facility’s physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. The facility is a one-story structure located in a residential neighborhood. Outside of the facility was observed to be cleaned and clear of obstructions. Swimming pool in the backyard was observed to be fenced and locked and inaccessible to residents in care. Additionally, LPA observed outdoor furniture for residents’ use and area for outdoor activities. Entrance, exits and hallways were observed to be clear of obstructions. LPA observed 6 private resident bedrooms and 3 bathrooms for resident use. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the resident's personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit. Bathrooms were operational and adequately supplied including with grab bars and non-skid flooring. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were locked and not accessible to residents in care. The kitchen was inspected, and sufficient 2-day perishable and 7-day non-perishable food was maintained adequately. Room temperature was maintained in the facility at 76 degrees F. Water temperature in one of the bathroom was measured at 119 degrees F. The fire extinguisher located by the exit to the garage was serviced on 5/29/24. Smoke detectors and carbon monoxide were tested and found to be operable during this visit. {Con't to LIC 809-C...} {...Con't from LIC809} Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed for accuracy. First aid kit was observed to have adequate supplies and accessible to staff. The facility maintains for each resident Centrally Stored Medication, Destruction Record and PRN Log. LPA observed personal rights, resident council and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s sufficient equipment and supplies to meet activity program needs of residents in care. During this inspection, LPA conducted an audit of facility files, 6 resident files, and 4 staff files for regulatory compliance. All staff noted on LIC 500 have criminal background clearances and associated to this facility. LPA attempted 2 resident interviews and 2 staff interviews. 6 out of 6 Resident files reviewed contained all Facility maintain resident records including updated admission agreements, medical assessments, and updated appraisal forms as required. 4 out of 4 staff files reviewed contained all required contents including health screening, TB results, current first aid/CPR, and initial and ongoing required training. Facility’s liability insurance is current per regulatory requirements. Facility conducts quarterly fire drills. LPA requested an updated copy of current liability insurance, LIC 308 and LIC 500. Per California Code of Regulations (CCR), Title 22, no deficiencies were observed. An exit interview was held, and a copy of the report was given.the state’s words, verbatim · CDSS document, Jun 5, 2024