Simi Valley Residential Care V

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival, the LPA met with staff and explained the reason for the visit. Licensee Marie Mendez arrived shortly after. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. LPA inspected the kitchen/food service area at approx. 10:20 a.m. Knives and sharp objects are stored in a locked drawer to the left of the stove. No cleaning supplies were observed kept in the kitchen area. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored at this time. There is an attached garage. LPA observed garage to be inaccessible to residents in care. LPA observed additional fridge and freezer to store extra perishable food. LPA also observed additional non-perishable supplies, canned goods, PPE, extra incontinent supplies, as well as additional furniture and medical equipment for facility use. Laundry area was located in the garage as well. At the time of the visit, the common area furniture's were observed to be in good condition. A sufficient supply of clean linen and towels were observed stored in the hallway cabinets. Board games and other activities were observed throughout the facility. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. LPA observed fire extinguishers to be fully charged and serviced 08/11/2025. LPA observed five (5) resident bedrooms total. There is also one (1) bedroom designated for staff use. Resident bedrooms were observed furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bathrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured between 105 - 120 degrees Fahrenheit. LPA observed staff room to be inaccessible to residents in care and empty at the time of the visit. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings throughout the common areas. The backyard has a covered outdoor area equipped with furniture including tables and chairs for resident use. The LPA observed two (2) self-latching gates with clear passageways clear of obstruction. There were no bodies of water noted at the time of the visit. Records review four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All records were observed to be in order at this time. Six (6) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Medication review, medications for all residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Infection control / Emergency Disaster plan: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are to be conducted quarterly; the facility’s last emergency disaster drill was conducted on 01/28/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s administrator. Smoke detectors and carbon monoxide detectors were tested, all alarms were functional at the time of the visit. The LPA obtained the following documents at the time of visit: LIC500 Personnel Report, LIC9020 Client Roster, and a copy of the facility’s liability insurance. Interviews were conducted during the visit. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Mar 4, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival, the LPA met with staff and explained the reason for the visit. Licensee Marie Mendez arrived shortly after. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. LPA inspected the kitchen/food service area at approx. 10:00 a.m. Knives and sharp objects are stored in a locked drawer to the left of the stove. No cleaning supplies were observed kept in the kitchen area. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored at this time. There is an attached garage. LPA observed garage to be inaccessible to residents in care. LPA observed additional fridge and freezer to store extra perishable food. LPA also observed additional non-perishable supplies, canned goods, PPE, extra incontinent supplies, as well as additional furniture and medical equipment for facility use. Laundry area was located in the garage as well. At the time of the visit, the common area furniture's were observed to be in good condition. A sufficient supply of clean linen and towels were observed stored in the hallway cabinets. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. LPA observed fire extinguishers to be fully charged and serviced 08/05/2024. LPA observed five (5) resident bedrooms total. There is also one (1) bedroom designated for staff use. Resident bedrooms were observed furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bathrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured between 105 - 120 degrees Fahrenheit. LPA observed staff room to be inaccessible to residents in care and empty at the time of the visit. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings throughout the common areas. The backyard has a covered outdoor area equipped with furniture including tables and chairs for resident use. The LPA observed two (2) self-latching gates with clear passageways clear of obstruction. There were no bodies of water noted at the time of the visit. Records review began at approx. 10:20 a.m. four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All records were observed to be in order at this time. At approx 10:45 a.m. Four (4) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Last emergency disaster drill was conducted on 01/03/2025. Medications review began at approx. 12:30 p.m. All medications including PRNs were labeled, stored and inaccessible to residents in care. Medications were observed to be administered as prescribed at this time. At approx 01:30pm, LPA discussed Infection control: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of a communicable disease. The facility has an adequate supply of Personal Protection Equipment (PPE), and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of an infectious disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time. The LPA obtained the following documents at the time of visit: LIC500 Personnel Report, LIC9020 Client Roster, and a copy of the facility’s liability insurance. Interviews were conducted during the visit. Exit interview conducted, discussed and copy of report issued.the state’s words, verbatim · CDSS document, Feb 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. LPA met with staff and reason for visit was explained. Licensee Maria Mendez was contacted. The LPA and staff toured the physical plant areas inside and outside at approximately 11am to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. BEDROOMS: The LPA observed four (4) single-occupancy and one (1) double-occupancy resident bedrooms. Four of the bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The one (1) double-occupancy resident room was observed vacant during todays visit. RESTROOMS: Three restrooms observed clean and sanitary; fixtures in operating condition. Hot water temperature tested (114'F) and observed to be within required range (105-120'F). COMMON SPACES: At the time of the visit, living room and dining room furniture was observed to be in good condition. KITCHEN: Knives were stored in a locked drawer and cleaning supplies were stored in the locked cabinet under the sink and garage. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher appeared fully charged and observed last inspected on 07/14/2023. Resident files were reviewed at approximately 11:30am for updated Needs and Services plans, medical assessments, admission agreements, and all other pertinent documents in their files. R3's hospice records were not complete - updated care plan service, and no written proof of training provided by Hospice on file. A technical violation was issued at this time. Staff records were reviewed at approximately 12:30pm and noted to be complete for first aid certification, health screening documentation, training requirements, employee rights and criminal record clearance. All staff and resident files were observed to be complete at this time. Medications are kept in locked cabinets in the office area. LPA reviewed medications and physician’s orders with Mrs. Mendez at approximately 1:30pm for all three residents and found they are being given as prescribed. Technical violation was issued for prescription label altered (R2). Exit interview held. Copy report provided.the state’s words, verbatim · CDSS document, Mar 22, 2024

The state marks this report as 5 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.