Pleasant Valley Memory Care

Type of visit: Post Licensing

Licensing Program Analyst, Noel Wolf Petersen arrived unannounced to conduct the post licensing visit. LPA Met with Administrator Stephany Isakhani, LVN, to explain the purpose of the visit. LPA toured the facility it is clean and traffic areas are unobstructed. LPA reviewed 5 Staff files for the health screenings, background checks, current and annual trainings, first aid certifications. Staff files are present and up to date. LPA review 5 client files for the signed admission agreements, needs and services plans, health screenings, safegaurded property, and 602 medical health assessments. Client files are present and up to date. Admission agreement revisions are going out over the next moth, LPA gave guidance about needs and services plan update procedures. LPA interviewed 5 staff. LPA interviewed 3 clients. no citations associated with the visit. A copy of the report was read and given to the administrator. exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 19, 2026

Allegation investigated: Staff did not issue a refund to a resident in care.

The Licensing Program Analyst, LPA arrived to the facility to the facility to conduct a complaint investigation, into the above allgations. The LPA met with the administrator Stephanie Issakahini to explain the purpose of the visit. In interview it was learned a resident(r1) was relocated from the facility, January 9th 2026, dying under the care of another facility January 12th 2026. The estate representatives of r1 sought a claim on the facility of prepaid monthly rate prorated to 21 days(1168.14$) as a refund for services not rendered to the client(client being incapacitated by death). LPA recived a copy of the resident(r1) admission agreement, and it and its attached addenda does not state refund conditons. The policy should be contained in the admission agreement as outlined in health and safey code 1569.884(h), "The facility’s policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned...". Continued on C page. Substantiated Because of the facilities admission agreement not having a refund policy, the agreement being discussed is then without a document supporting it. LPA reviewed communication from the facility to representatives of the estate outlining an argument against paying a refund, but on the basis of not providing 30 days notice to quit. LPA's review of the admission agreement does state, "Provide 30 days notice of intent to move from the home unless the resident's physical condition prevents this from being done", creating a unintended interpretation of the document where a incapacitated resident could undermine the facilitiys reasoning to not pay a refund for services not performed in the month they moved out. Per interview with administrator, a refund is in process of being issued, for an amount agreed to by the estate. LPA is asking for the check to be sent certified, and the party representing the resident to be notified of the incoming refund, the administrator should send the LPA confirmation of the receipt of the check. Noel.wolfpetersen@dss.ca.gov LPA agrees that settling the dispute, even without a defined document with terms of the refund, is probably the best course of action, rather than continue the disagreement in civil court with the current basis of not providing 30 days notice to quit. LPA notes the facilitys new refund policy will be provided with an updated admission agreement, to the LPA 6/7/2026, As the ownership structure of the License has recently changed and the obligations being paid appear to be handshake based, a Technical Violation was issued with a substantiated finding rather than a citation, a copy of the report was read and given to the administrator. A copy of the appeal rights was provided. exit interview conducted.the state’s words, verbatim · CDSS document, Jun 1, 2026 · control 27-AS-20260526112535

Type of visit: Prelicensing

Licensing Program Analysts,(LPA's) Noel Wolf Petersen and Jason Lund, arrived announced to the facility on 3/18/26 to conduct a Prelicensing visit with a change of ownership. LPA's met with the administrator Jagbir K Dhillon to explain the purpose of the visit,(Lic 200 is necessary to change from Jennifer Whiteley to Jagbir). Physical inspection was conducted: including the bedrooms, bathrooms, common areas, kitchen, exterior, and evacuation routes. Bedrooms had required furniture and furnishings, including mattress encasements. Bedroom slider doors to the exterior checked at random were able to open. Bathrooms had functional hardware, grab bars checked at random. water temperature was measured between 105 and 120*F. Kitchen has food and food storage for 2-days perishable, 7-days nonperishable, the drains are clear of debris. There's lockable storage for toxic and sharps. evacuation routes have alarmed push bars. Fire extinguishers, 1/6/26. First aid kit has all necessary items. Facility required posters are up to date and present: (administrator certificate, facility sketch, ombudsman/emergency services/ccld contact numbers) Signal system is functional, 2 minute response time. Five staff were interviewed regarding thier job specific training, the client personal rights, and abuse reporting. 5 Staff files were reviewed, to include but not limited to health screenings, initial and continuing trainings, cpr/first aid. staff Files are present and up to date. 5 client files were reviewed at random, to include but not limited to the health screenings, preappraisals, functional capability assessments, needs and services, signed admission agreements, and amendments to the admission agreement. Client files are present and up to date. No citations as a result of this visit. a copy of the report was read and given to the administrator, as a result of this inspection, the LPA's find no reason to deny licensure at this time. Exit interview was conducted.the state’s words, verbatim · CDSS document, Mar 18, 2026

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, Oct 1, 2025