Providence Place

Type of visit: Required - 1 Year

On 8/13/2026, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Health & Wellness Director (HWD) Catherine Aquino. LPA explained the purpose of the visit. LPA toured the facility inside and outside including resident rooms, common areas & kitchen area. The indoor and outdoor passageways were free of obstruction. This is a 4-story building with 17 bedrooms, 6 bathrooms, a dining room, living room, kitchen, laundry room, offices, and garden. LPA observed some residents were in the designated activity areas. The residents have adequate amount of linens and incontinence care items. All personal belongings are intact. Water temperature was at 110 degF and facility temperature was at 70 degF. All fire extinguishers have been checked and current. Resident bedrooms and bathrooms were observed to be in good repair equipped with grab bars and non-skid floors. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Emergency drills are logged and done every quarter. LPA reviewed six resident records and five staff records. Resident records are updated, complete and signed. Staff records are complete. All medications are accounted for, and centrally stored medication records are updated. No deficiencies are cited at this time. Report is reviewed with Administrator and a copy is provided.the state’s words, verbatim · CDSS document, Aug 13, 2026

Allegation investigated: Facility staff worked without a criminal record clearance

On 3/25/2026, LPA Grace Donato made an unannounced complaint investigation visit to the facility. LPA met with Health & Wellness Director (HWD) Catherine Aquino. LPA explained the purpose of the visit. For the allegation of facility staff worked without a criminal record clearance, Reporting Party (RP) reported that RP did not obtain a criminal record clearance prior to working with residents. During the investigation the HWD admitted to having a staff worked at the facility with no fingerprint clearance. An immediate civil penalty of $500 was assessed due to a staff member not having a fingerprint clearance. Deficiencies are cited under the California Code of Regulations. Failure to correct the deficiencies by the POC due date may result in Civil Penalties. A copy of this report along with Appeal Rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Mar 25, 2026 · control 14-AS-20260320092212

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(j) · Plan of correction due date: Mar 25, 2026

(j) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees in the individual's personnel file as required in Section 87412, Personnel Records. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above due to S1 having no criminal record clearance while working in the facility which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 25, 2026

Plan of correction: Licensee has already terminated staff and has submitted the POC.

Type of visit: Required - 1 Year

On 8/27/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Catherine Aquino, Health & Wellness Director and explained the purpose of the visit. LPA toured the physical plant. This is a 4-story building with 17 bedrooms, 6 bathrooms, a dining room, living room, kitchen, laundry room, offices, and garden. All bedrooms had the required furniture and sufficient lighting. No accessible bodies of water or hazards were observed in the hallways or outside. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature. The facility's fire extinguisher was observed to be in working order. Hot water was measured between the required 105-120 degrees Fahrenheit. The facility's first aid kit was observed to have all the required items. All sharp objects, soap, detergent, medications, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 5 resident files and 6 staff files. All were observed to be complete. Medications were reviewed and found to match Centrally Stored Medication Records kept at the facility. LPA received the following documents at the facility: Resident Roster as of 8/27/2025 Resident Admission Agreement Theft and Loss Policy LIC 500: Personnel Summary Report Certificate of Liability Insurance Annual Fire Alarm Certification dated 3/21/2025 Articles of Incorporation LPA requested the Licensee send the following documents by Friday, September 12th, 2025: Control of Property such as a deed or mortgage statement Facility's Transportation Policy LPA interviewed 3 residents and 1 staff. No deficiencies were cited during today's visit. An exit interview was conducted. A copy of the report was left with the facility representative.the state’s words, verbatim · CDSS document, Aug 27, 2025

Type of visit: Required - 1 Year

On 8/8/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Caregiver Staff, Joy Bautista. Wellness Director, Catherine Villegas was contacted and arrived later in the visit. The facility currently provides care for 34 residents, 2 of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located on each floor were found to be last charged on 6/6/2024. Smoke and carbon monoxide detectors are interconnected. Fire Safety Inspection was completed on 7/23/2024 indicating all fire safety devices and systems to be in order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen refrigerator found to have appropriate coverings, sufficient for residents in care. Facility allows residents to choose meals on various preferences while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked closets throughout each floor, all of which were secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Residents that were awake during the inspection were observed interacting with staff in the common areas, or in their bedroom resting. In addition, there is large outdoor backyard space for resident use. The facility encourages regular family visits and utilizes a wide variety of activities. The Activities Director and caregiver staff were observed engaging continuously with residents, offering activities based on individualized preferences and abilities. LPA found that the engagement is very well practiced with activity calendars developed on a monthly. Residents were observed to have a positive relationship with staff. Continued onto LIC809-C LPA conducted a sample file review for 10 residents and found three (3) residents requiring Needs & Service Plans updated. Upon a check of spot check of seven (7) staff files, LPA found that caregiving staff have current 1st aid and CPR and annual training on schedule for completion. LPA found that the staff require additional training on dementia care. LPA was informed that the training has been scheduled for this month. Licensee to ensure training for staff is completed by 9/8/2024. Technical Assistance. Lastly, A spot check of medications was conducted and found that all medication counts and records are in order. Galina Knop's Administrator Certificate 7034765740 is currently active through 2/21/2025. Roman Knop's Administrator Certificate 7034766740 is currently active through 12/1/2025. LPA requested the following documents be sent to CCL by COB 8/22/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Aug 8, 2024