Simi Valley Residential Care VI

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit. Upon arrival, the LPA met with staff, Cassidy Schwab, who contacted the Licensee via telephone. Licensee, Maria Mendez, arrived at the facility at 10:24 A.M and the reason for the visit was explained. Administrator, Jennifer Fulgentes, arrived shortly after. LPA and the Licensee 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. COMMON AREAS: 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 temperature of 70 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 08/14/2025. Activities and board games were observed stored in the main hallway. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings posted throughout the home. During the plant tour, LPA observed a camera in the hallway facing residents’ rooms. According to the Licensee, the device is currently out of service and not operational. BEDROOMS: LPA observed six (6) resident bedrooms and one (1) staff room. Resident bedrooms were observed furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Staff room was inaccessible to residents in care at this time. Continued on LIC 809-C Continued from LIC 809 BATHROOMS: Bathrooms were observed to be clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured between 105 - 120 degrees Fahrenheit. BACKYARD: 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. The LPA observed a locked shed with gardening tools inaccessible to residents in care. No bodies of water were noted at the time of the visit. GARAGE: There is an attached garage. LPA observed garage to be inaccessible to residents in care. LPA observed an 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 along with an office area. KITCHEN: LPA inspected the kitchen/food service area at approx. 10:55 A.M. Knives and sharp objects are stored inaccessible in a drawer to the left of the stove. No cleaning supplies were observed stored 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. Dining area was observed to be clean, and furniture appeared to be in good condition. LPA observed facility files and medication properly stored inaccessible in a cabinet next to the dining area. RECORDS REVIEW: Starting at 11:20 A.M. Six (6) resident and seven (7) personnel records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. LPA observed that Resident #1 (R1) Tuberculosis (TB) test was missing. Although an order for a chest X-Ray was on file, there was no documentation confirming completion of the X-Ray or any TB test result. Additionally, Staff #1’s (S1’s) medical assessment was misplaced. Technical Violation (TV) issued All other records were observed to be in order at this time. Continued on LI C809-C Continued on LIC 809-C MEDICATION REVIEW: Medications are centrally stored in a locked cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. At 1:55 P.M., LPA conducted a medication audit. Medications are properly documented on the centrally stored medications and destruction record. Medications appeared to be given as prescribed at the time of the visit. The LPA obtained the following documents at the time of visit: Personnel Report (LIC500), Resident Roster (LIC9020), last emergency disaster drill, and a copy of the facility’s liability insurance. Additionally, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. Emergency disaster drills are conducted quarterly, with the last drill conducted on 02/06/2026. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 7, 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. Administrator Maria Mendez 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. 09:40 a.m. Knives and sharp objects are stored inaccessible in a drawer to the left of the stove. No cleaning supplies were observed stored 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. Dining area was observed to be clean and furniture appeared to be in good condition. LPA observed facility files and medication properly stored inaccessible in a cabinet next to the dining area. 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 along with an office area. 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. Staff room was located next to the bedroom #2. It was observed to be empty and inaccessible at this time. LPA observed six (6) resident bedrooms total. 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. Activities and board games were observed stored in the main hallway. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings posted throughout the home. The backyard has a covered outdoor area equipped with furniture including tables and chairs for resident use. The LPA observed two (2) self-latching gate with clear passageways clear of obstruction. The LPA observed a locked shed with gardening tools inaccessible to residents in care. No bodies of water were noted at the time of the visit. Records review, five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At approx. 10:45 a.m. Five (5) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were observed to be in order at this time. Medications review, medications are centrally stored in a locked cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are properly documented on the centrally stored medications and destruction record. Medications appeared to be given as prescribed at the time of the visit. Infection control, 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, Apr 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required Annual inspection today. Upon arrival, there were two (2) staff members and six (6) residents present. The LPA was greeted at the door by staff, Nhoel Villanueva and the reason for the visit was explained. The Administrator, Maria Mendez arrived at 9:35 a.m. Entrance interview conducted. At 9:40 a.m., the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA inspected the kitchen/food service area at 10:00 a.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and pantry were checked for proper labels and expiration dates. Knives and sharps were observed in a locked drawer inaccessible to residents in care. COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. At 10:05 a.m., the smoke detector(s) and carbon monoxide detector were tested and operational. Fire extinguishers were observed fully charged with a date of 07/12/2023. There is a locked closet in the hallway with personal hygiene items inaccessible to residents in care. The LPA observed required postings throughout the common space. There is a working telephone on premises. Indoor cameras were observed throughout the common areas. Continued on LIC 809C... Continued from LIC 809... GARAGE: The garage connects through the kitchen. The washer and dryer were observed inside the garage. Detergents and cleaning supplies were observed in a locked cabinet inaccessible to residents at the time of the visit. An adequate supply of emergency food and water was observed at the time of the visit. BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There are two (2) side gates with closing mechanism. The LPA observed a locked shed with gardening tools inaccessible to residents in care. No bodies of water were noted at the time of the visit. BEDROOMS: There are six (6) resident bedrooms which are all for single occupancy. LPA observed the resident bedrooms to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. There is a designated staff room on premises. RESTROOMS: There are three (3) resident restrooms. Restrooms were observed with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. Starting at 9:43 a.m.., the hot water temperature was measured in all three (3) bathrooms, and they measured between 108.6- and 112.1-degrees Fahrenheit. RECORDS: Records review began at 10:15 a.m.; six (6) resident records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. Records were in order. Three (3) personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Files were complete. The last emergency disaster drill was conducted on 04/15/2024. Continued on LIC 809C... Continued from LIC 809C... The LPA obtained copies of the following documents at the time of the inspection: Personnel Report LIC 500, Client Roster LIC 9020, Emergency Disaster Plan LIC 610E, and current Limited Liability Insurance. MEDICATIONS: Medications review began at approximately 12:20 p.m.; medications are centrally stored in a locked cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are properly documented on the centrally stored medications and destruction record. Medications appeared to be given as prescribed at the time of the visit. Exit interview conducted. No citations issued. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Apr 29, 2024