Rc Premier Villa II

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an unannounced case management inspection. LPA met with staff, Carlene Faskin and Cecil Shaw. LPA spoke to Administrator, Zadel Cabrera, and stated the reason for the inspection. LPA observed an electrician installing a new light in the front common area and completing the project around the end of the inspection. The area was not occupied by residents during the installation. LPA observed (3) residents in the common area and (3) residents in their rooms. During today's inspection, LPA spoke to the Administrator regarding her email received earlier today and concerns with resident (R1's) behavior toward staff, residents and home health staff. LPA spoke to the (2) staff who were present, who also shared concerns about (R1's) behavior. One of the staff showed LPA how staff have been documenting specific incidences of behaviors (R1) has shown to staff to others. LPA discussed Regulation 87224/Eviction and the lawful reasons for an eviction and stated she would provide a copy of the regulation to reference when writing an eviction letter. LPA suggested (R1) be provided with a copy of the facility's House Rules as a reminder of what behavior is expected from residents. LPA spoke with resident (R2) who shared specific examples of incidents they have observed/heard (R1) say to staff and other residents. LPA reviewed paperwork from (R1's) file, including the signed Admission Agreement, care plan and physician's report. LPA observed a signed copy of House Rules in (R1's) file. LPA toured the facility and observed it to be clean, safe, sanitary and in good repair. There are no deficiencies issued in this report. LPA to follow up with the Administrator later this week. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 25, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual Inspection and met with Zadel Cabrera, Administrator, and MJ Cabrera, House Manager. Also present were staff, Joan Simbajon and Alfred Flores. LPA observed (2) residents in the common area and (3) residents in their rooms. LPA was advised (1) resident was currently in the hospital. The facility is licensed for (6) non-ambulatory residents and has an approved hospice waiver for (2). Currently there are no residents under hospice care. Dinner was served at 4:40 pm. LPA and the administrator toured the interior and exterior of the facility, including the common areas, (4) private resident bedrooms and (1) shared resident bedroom, staff room, bathrooms, kitchen, laundry and patio. All areas were observed to be clean, in good repair and odor free, and there were no obstructions to any doors. Staff are aware where the utility shut off valves are. There was 2+day perishable and 7+day non-perishable food supply and an additional freezer. LPA observed locked medications and sharps in the kitchen and office area and locked toxins near supplies. All doors have working alarms, and the fire extinguisher was last serviced 7/7/25. There are sufficient blankets/linens/towels and a complete First Aid kit. Hot water measured 118*F in the kitchen, and the inside temperature measured 73*F. The outside patio area joins with the patio of the adjacent related facility. There is seating also. There are no pools/ponds. LPA reviewed (2) resident files and multiple staff files. All files were organized and contained current/required documentation. Scheduled and on-call staff are completing the required training hours through an approved vendor and have current certification in First Aid/CPR. Medications were reviewed for (1) resident. Orders matched medications and documentation was current. All exit doors have alarms. All required postings are in the common area. Discussed multiple regulation updates made earlier in 2025, and an updated Dementia Care Plan is on file. LPA obtained an updated copy of the insurance policy. All facility contacts are current. There are no deficiencies cited during today's inspection. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Dec 4, 2025

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a Post-Licensing Inspection and met with Johngie Somar, Assistant House Manager. Also present was staff, Latroya Latesha and Cecil Smith. The Administrator, Zadel Cabrera, arrived at 12:00 pm and a resident returned at 12:10 pm. The facility is licensed for (6) non-ambulatory residents and has an approved hospice waiver for (2). Currently there are no residents under hospice care. LPA observed lunch being served in the common area. LPA and others toured the interior and exterior of the facility, including the common areas, (4) private resident bedrooms and (1) shared resident bedroom, staff room, bathrooms, kitchen, laundry and patio. All areas were observed to be clean, in good repair and odor free. There was 2+day perishable and 7+day non-perishable food supply. LPA observed locked toxins, medications and sharps. All doors have working alarms, and the fire extinguisher was last serviced 7/7/25. LPA reviewed (2) resident files and staff files. All files were organized and contained current/required documentation. Scheduled and on-call staff are completing the required training hours per regulation and have current certification in First Aid/CPR. All exit doors have alarms/alerts that sound. All required postings are in the common area. LPA to update facility land line and email address as requested. LPA requested an updated copy of liability insurance. LPA discussed annual inspection to be completed by end of the calendar year. There are no deficiencies cited during today's inspection. Exit interview. Copy of report to be emailed due to technical issues.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection and met with MJ Cabreara, House Manager, stating the reason for today's inspection. Administrator, Zadel Cabrera, was contacted and indicated she was unavailable during the inspection. The Department received (2) incident reports (LIC624) on February 14, 2025, reporting the following: The LIC624 from February 12, 2025 states that at 1:45 pm, (R1) stated they wanted to go to the store and left the house. The report notes that a caregiver tried to stop resident from leaving as they cannot leave the facility unattended but the resident stated they can do what they want. The facility contacted the police to stop (R1) but the police stated they cannot stop the resident. The facility called 9-1-1 to take resident to the hospital for a change in condition due to increased confusion, but the resident refused to go . The police stated resident can make their own choices since they are not conserved. (R1) agreed to return to the care home providing the care giver take them to the store. The LIC624 from February 13, 2025 states around 1:00 pm, (R1) was found to be missing from the home and the police was contacted after an immediate search was done. (R1) was found walking in the rain and agreed to return to the facility if caregiver took them to the store again. (R1) was brought back and attempted to leave one more time that afternoon, when waiting for the ambulance, around 4:00 pm. The Administrator contacted LPA promptly after (R1) was observed missing and stated that (R1) was smoking on the back patio, and staff went to care for another resident. When the staff had returned (10) minutes later, resident had left the facility. (R1's) physician's report, dated August 14, 2024, indicates that (R1) is not able to leave the facility unattended due to her mental status. The Administrator was contacted by the emergency room physician after (R1) was sent there to advise that (R1) would be transferring to a secured memory care. Per California Code of Regulations, Title 22, Chapter 6, Division 8, the following (1) citation is issued on the 809-D page. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(d) · Plan of correction due date: Feb 19, 2025

87705 Care of Persons with Dementia. (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Based on information submitted to the Department on February 13, 2025, the Licensee did not ensure that (R1) was unable to leave the facility unassisted, which posed an immediate health and safety risk to residents in care. The front door does have an auditory alert; however, staff did not hear it when it sounded.the state’s words, verbatim · CDSS document, Feb 18, 2025

Plan of correction: Licensee/Administrator agrees to conduct staff training on preventing elopements, change the auditory device so it can better alert staff, consider using staff pagers so staff can be alerted. Also facility will consider using a tracking device, approved by the local police, for any other residents that have a high risk of elopement, provided it doesn't violate resident rights. House Manager to submit a training plan (date to be trained) and confirm possible solutions by tomorrow, 2/19/25. Also indicate by 2/19/25 estimated resolution.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sabrina Calzada conducted a scheduled Pre-Licensing Inspection on 10/2/24 (12:00 pm). LPA met with Zadel Cabrera, Administrator, and members, Juvy Bartolome and Angeline Lardizabal, and Jasel Requillo. Also present was caregiver, Joselito Sayas. LPA observed (3) residents sitting in the common area and (2) residents resting in their rooms. Administrator for the current license, Marikar King, was also present. The reason for the pre-licensing is due to a change in ownership. The facility is currently licensed for (6) non-ambulatory residents, (2) of whom are approved for hospice. Currently there are no hospice residents. LPA and others toured the interior and exterior of the facility, including the common areas, resident bedrooms, staff room, bathrooms, kitchen, laundry and patio. The facility was observed to be clean, in good repair and to have sufficient furniture and lighting throughout. Resident bathrooms have grab bars and non-skid flooring, and there are (20) second hand-washing posters by each sink. There is sufficient 2+day perishable and 7+day non-perishable supply of food. The hot water measured 108*F in the kitchen and the inside temperature measured 77*F. Sharps and medications are locked in the kitchen and toxins are locked in a separate cabinet in the common area. All doors have working alarms, and the fire extinguisher was last serviced 7/25/24. The smoke/monoxide alarms are working and the fire door automatically closed when the alarms were tested. There are blankets/linens/PPE supplies on hand. Residents use a necklace pendant to call for assistance. There is one unlocked exit outside on the patio. All required postings are posted in the common area. Inside temperature measured 77*F. Resident and staff binders are organized and complete. Comp III was conducted during today's inspection. Pre-licensing is complete and this facility has no deficiencies. LPA to notify analyst in application unit. Exit interview. Copy of report provided to the Administrator.the state’s words, verbatim · CDSS document, Oct 2, 2024