Providence Home of Vallejo

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Cuadra arrived unannounced to conduct a Required -1 Year visit, and met with administrator, Michelle Jangar. Annual fees are current. Required postings observed. LPA/administrator toured the facility common areas, hallways, residents rooms, kitchen and bathrooms observed had sufficient lighting. Residents rooms are furnished per regulation. The facility was a comfortable temperature. Passageways were free of obstructions. Facility has a sufficient supply of cleaners, hygiene items and paper products. A call button is located in each bedroom, LPA tested the call system in resident's rooms and staff response time was under three minutes. A tour and inspection of the kitchen area were found to be clean and sanitary. The kitchen was observed to have a sufficient supply of perishable and non-perishable food. Prepared and left over foods were covered and labeled. LPA/administrator observed that there were no snacks been provided to residents between meals. LPA had a conversation with the administrator regarding the importance of providing snacks to residents in care. LPA observed the facility has supply of fruits and vegetables (technical violation issued). The facility has emergency supplies, including food and water to meet requirements of the 72-hour shelter in place. Resident and staff files are located in the dining room and locked in cabinet. All medications were all locked and inaccessible to residents in care. No activities were conducted during LPA's visit (technical violation issued). LPA had a conversation with the administrator about the importance of activities. Facility's smoke and carbon monoxide detectors were operational. Bathrooms have non-skid surfaces and grab bars at the toilet and shower areas. Continued on LIC809C... Continued from LIC809... Fire extinguishers last charged and serviced on June 2026. Exit doors have auditory alarms to alert staff. Hot water measured 104.2 degrees F, which is not within regulation of 105 to 120 degrees F at faucets used by residents in care (technical violation issued). - At 9:45 AM, LPA conducted a file review of three staff and five residents. All staff have current 1st aid/CPR certificates updated and completed all required training hours. There are residents receiving hospice care services within the approved hospice waiver. Two out of five residents (R3 & R4) do not have a current care plan and residents (R1 and R2) care plans are incomplete because administrator did not include reposition, history of skin breakdown and incontinence care as specified in their physician's reports (LIC602) for staff to be able to provide assistance and supervision of these needs. Based on interviews with staff (S1 & S2) they were aware of these care needs and they are assisting residents with adequate care (technical violation issued). Residents have half bed rails doctor's order on file. Administrator agreed to update care plans accordingly. Administrator Michelle Jangar, administrator certificate 7002269740 expires on 10/25/2027. Medications and medication records were reviewed. At approximately 10:00am, LPA/administrator reviewed residents (R1 & R4) records that revealed that they both has a diagnosis of diabetes, their physician report (LIC602) determines that they are not able to administer own injections or perform own glucose testing. Administrator acknowledges that R1 & R4 have a diagnosis of diabetes, but confirmed that they do not have a glucometer and accessories to daily monitor residents' glucose levels. At approximately at 11:45am LPA/administrator observed that last fire drill was conducted January 21, 2026, the facility has not been conducting drills quarterly. Administrator agrees to submit updates of the following documents by not later than 6/17/26: (LIC 500) Personnel Report, (LIC 308) Designated facility responsibility & copy of liability Insurance. Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, and the Health and Safety Code. Appeal Rights Given. Exit interview conducted with Administrator and copy of this report was given.the state’s words, verbatim · CDSS document, Jun 3, 2026

The state marks this report as 10 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: -Personal Rights.

Licensing Program Analyst (LPA) Cuadra conducted an unannounced visit and met with Administrator Michelle Jangar. LPA came to the facility to investigate and deliver findings of above complaint allegation. The Department received an allegation of Personal Rights. Per Reporting Party, resident (R1) they have been keeping constant communication, but on 5/8/26, they were unable to contact R1 with their cell phone, then they called the facility where they were able to connect with R1 and were told that facility staff took their phone away for unknown reason. According to Reporting Party, in the past, R1 contacted them telling them "hey come get me I need to escape a little bit from here". Also, R1 expressed that they are isolated in the home and that "no one speaks English". On 05/18/26, LPA conducted a 10-day visit, reviewed records, made observations, interviewed residents (R1, R2, R3 & R4) and staff (S1 & S2). Based on interviews conducted with residents (R1, R2, R3 & R4), it indicates that residents feel that their personal rights are respected providing information about their freedom and choice to receive/make phone calls or visitors at any time. Continues on LIC9099C... Unsubstantiated Continued from LIC9099A... R1 stated that they get assistance from all staff when needed including assisting them to place phone calls because they are learning to use their new device, but they did not provide any supportive information regarding staff not allowing them to use their phone. Interviews conducted by LPA with staff (S1 & S2) indicated that they are assisting residents when they need to make a phone call to anybody, they help by locating the contact name of the person that they want to call, then they leave the room to allow them to have privacy. Based on LPA's observations, residents who has a cellphone, the devices were in their possession at the time of visit and they were able to locate them. Also, LPA observed staff's interactions with residents where they were able to held a conversation with residents in care. Based on records review of the facility admission agreement page #13-14, item E regarding guest visits and communication, the facility visiting hours are between 10am- 6pm daily, offers telephone services as follow: “personal calls are accepted from 10am to 7pm, except urgent matters”. Based on records review, R1's physician report indicates that R1 doesn't have any cognitive challenges. Based on interviews, observations and records review, LPA is unable to determine if a violation of personal rights occurred at a prior date. A finding that the allegation of facility violating resident's personal rights is unsubstantiated meaning that 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 allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, May 18, 2026 · control 21-AS-20260508141452

Type of visit: Required - 1 Year

At approximately 8:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Michelle Jangar and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 6 residents. At approximately 9:00AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen contained cooking/dining equipment that was clean and orderly, utensils were present. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required seven-day non-perishable and two-day perishable supply of food. Emergency food stores and water was present to ensure facility can be self-sufficient for 72 hours. Emergency lighting devices were present. First aid kit was present. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. Facility has not been conducting Emergency drills every 3 months. At approximately 10:00AM, LPA reviewed 5 of 6 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. Documentation of physician visits within the last 12 months. At approximately 11:15AM, LPA conducted a review of medications. Medication is locked and not accessible. Continued on LIC809-C... At approximately 12:20PM, LPA reviewed 4 of 4 staff files. Staff files reviewed did not contain evidence of completed annual training. First Aid/CPR certification was current. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Evidence of control of Property, (Current Rental/Lease Agreement/Deed) LIC500- Personnel Report LIC610E- Disaster Plan Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Michelle Jangar and Appeal rights were given.the state’s words, verbatim · CDSS document, Jun 6, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management-Legal/Non-compliance Inspection and met with Administrator, Renato "June" Yamat. LPA conducted a walk-through of the facility, and it was found at a comfortable temperature with all exits free from obstruction. The residents were observed to be comfortable, resting or engaged in activities. The refrigerator was observed with plenty of food that was stored properly and in good condition. Doors were properly alarmed. Resident rooms furnished as required. Bathrooms clean and sanitary with required non-skid mats and grab bars. Medications and sharps locked and secured. There are currently 6 resident in the home. There were 3 care staff on duty at the time of inspection. No citations issued during visit.the state’s words, verbatim · CDSS document, Feb 5, 2025

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management-Legal/Non-compliance Inspection and met with Administrator, Michelle Jangar and Renato "June" Yamat. LPA conducted a walk-through of the facility, and it was found at a comfortable temperature with all exits free from obstruction. The residents were observed to be comfortable, resting or with visitors. The refrigerator was observed with plenty of food that was stored properly and in good condition. Doors were properly alarmed. Resident rooms furnished as required. Bathrooms clean and sanitary with required non-skid mats and grab bars. Medications and sharps locked and secured. There are currently 6 resident in the home. There were 3 care staff on duty at the time of inspection. Facility is in communication with residents medical providers and trying to schedule a visit for residents to get the flu or Covid vaccination. No citations issuedthe state’s words, verbatim · CDSS document, Nov 18, 2024

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Case Management-Legal/Non-compliance Inspection and met with Renato "June" Yamat, covering Administrator. LPA conducted a walk-through of the facility, and it was found at a comfortable temperature with all exits free from obstruction. This facility was placed on non-compliance on May 1, 2023. The refrigerator was observed with plenty of food that was stored properly and in good condition. There is an additional refrigerator with food in the garage. The facility was found to be clean and residents appeared well cared for; clean and appropriately dressed. Medications and sharps were locked and inaccessible to residents. The outside of facility was free of debris and provided shaded seating areas for residents and visitors to enjoy. LPA went over compliance plan and reminded facility of the below agreement of 5/1/2023 between Community Care Licensing (CCL) and Facility, Providence Home of Aragon. Facility agreed to ensure proper bookkeeping and having adequate Finance staff and not commingle funds between all five (5) licensed facilities. Facility to ensure food costs are related to the resident census per facility. No citations issuedthe state’s words, verbatim · CDSS document, Aug 16, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year & Legal/Non-compliance Inspection and met with, assistant Administrator, Renato Yamat. There are currently 5 residents in care, with none of the residents receiving Hospice services. This facility is licensed for a total of 6 residents, with a hospice waiver to allow all 6 residents on Hospice services and no approval for bedridden residents/rooms. LPA toured facility and grounds and observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. This facility is a two story home and all resident bedroom are located in the first level and staff occupy the second level. LPA observed gates at the bottom of both stairs, but the gate in the front room needed to be adjusted. Residents have push button system to alert staff for assistance. Fire Extinguisher was found to be charged and last serviced on January 5, 2024. Smoke detectors and carbon monoxide detectors were tested and found to be operational during the inspection. Water temperature in resident bathrooms measured at 110 degrees and is within acceptable range of 105 to 120 degrees F. There was sufficient perishable and non-perishable foods located in the kitchen and garage and food is stored properly. Medications were centrally stored and locked. Cleaning products and other toxins are locked and inaccessible to residents in care. There was a supply of Linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats. A tour of all resident bedrooms was conducted, and bedrooms inspected have lighting and appropriate furnishing. Administrator certificate for Michelle Jangar #6008305740 expires 10/25/2025. Staff have the required training and proof of CRP/1St Aid. Resident files were reviewed. Continue report see LIC809-C Assistant Administrator and LPA discussed their Emergency Disaster Plan and Infection Control Plan. LPA went over Legal/Non-compliance plan and reminded Facility agreed to provide quarterly financial documents for the month February/March/April 2024 by May 17, 2024. Facility agreed to ensure proper bookkeeping and having adequate Finance staff and not commingle funds between all five (5) licensed facilities. Facility to ensure food costs are related to the resident census per facility. Licensee/Administrator to submit the current following documents by 6/29/2024: · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents Infection Control Plan of Operation (If changes) Liability Insurance Copy of current Lease Agreement No citations issued during this visit.the state’s words, verbatim · CDSS document, Jun 3, 2024

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management-Legal/Non-compliance Inspection and met with Renato "June" Yamat, covering Administrator. LPA conducted a walk-through of the facility, and it was found at a comfortable temperature with all exits free from obstruction. This facility was placed on non-compliance on May 1, 2023 for a one-year term. The refrigerator was observed with plenty of food that was stored properly and in good condition. There is an additional refrigerator with food in the garage. LPA went over compliance plan and reminded facility of the below agreement of 5/1/2023 between Community Care Licensing (CCL) and Facility, Providence Home of Aragon. Facility agreed to provide quarterly financial documents for the month of August/September/October 2023 by November 17,2023. Records for November/December 2023 and January of 2024 by February 16, 2024, and February/March/April 2024 by May 17, 2024. Facility agreed to ensure proper bookkeeping and having adequate Finance staff and not commingle funds between all five (5) licensed facilities. Facility to ensure food costs are related to the resident census per facility. LPA went over recent Hospice resident admitted (R1) in December 2023 and the facility notified Community Care Licensing (CCL) as required of new Hospice intake. R1 expired on 1/28/2024, and facility notified LPA as required and report is being completed and will be sent to CCL within the required time. No citations issuedthe state’s words, verbatim · CDSS document, Feb 1, 2024

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management-Legal/Non-compliance Inspection and met with Administrator, Michelle Jangar. LPA conducted a walk-through of the facility, that was found at a comfortable temperature with all exits free from obstruction. This facility was placed on non-compliance on May 1, 2023 for a one-year term. There are currently 3 residents living in the home. The refrigerator was observed with plenty of food that was stored properly and in good condition. LPA went over compliance plan and reminded facility of the below agreement of 5/1/2023 between Community Care Licensing (CCL) and Facility, Providence Home of Vallejo. Facility agrees to provide quarterly financial documents for the month of August/September/October 2023 by November 17,2023. Records for November/December 2023 and January of 2024 by February 16, 2024, and February/March/April 2024 by May 17, 2024. Facility agrees to ensure proper bookkeeping and having adequate Finance staff and not commingle funds between all five (5) licensed facilities. Facility to ensure food costs are related to the resident census per facility. LPA observed several furniture, mattress items in the yard patio and Administrator explained they have plans for a pick up by end of next week for removal. LPA went over requirements for facility with Dementia residents to ensure side yard gates are self closing and latching. LPA issued an advisory note to facility. No citations issuedthe state’s words, verbatim · CDSS document, Nov 3, 2023