Simla Villas

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection.LPA arrived unannounced, met with Administrator Jeniffer Bobadilla and explained the purpose of today’s visit.The facility is licensed to serve 15 residents age 60 and above. (11) may be non-ambulatory and (4) bedridden. Facility is approved for 4 hospice residents. The facility is located in Bellflower, CA. A tour of the facility includes: 9 bedrooms, 1 staff bedroom, 2 full bathrooms, 1 ½ bathroom, 1 staff bathroom, living room, dining room, kitchen, office area, laundry room, back yard with shaded area, detached garage and a detached shed. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility maintains the required Infection Control Plan. Operational Requirements: Facility maintains the required liability insurance that expires 5/16/27. Physical Plant & Environment Safety: Smoke detectors and carbon monoxide detectors are operable and in compliance. Bathrooms are clean and operational. All residents’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. The outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available to the residents. The hot water temperature was tested throughout the facility and was within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are stored in a secured/locked area and inaccessible to residents. The fire extinguishers were observed and is fully charged. Facility has telephone service on premises. There is a sprinkler system approved by the fire marshal throughout the facility. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Extra food is stored in detached garage. (Continued on 809-C) Staffing & Personnel Records-Training: There appears to be sufficient staffing at all times in the facility with at least one CPR trained employee on the premises at all times. Staff has criminal record clearance, current first aid and CPR, Dementia Training, Hospice Training, and ongoing training. Staff files are maintained at the facility and kept in a locked cabinet within the office area. Assistant Administrator Jennifer Bobadilla certificate expires 3/18/28. During todays visit LPA's observed 4 staff files with no issues. Resident Records-Incident Reports: Resident files are kept in a secure location within the staff office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Those on Hospice have the required information and documentation. LPA observed 5 resident files during todays visit with no issues. Resident Rights-Information: Complaint, Personal Rights and Ombudsman posters were observed in dining area. Residents are provided with telephone at the facility. Planned Activities: There is an activity schedule posted in the dining area. There are board games, books and daily newspaper readily available for residents. Incidental Medical & Dental: All medications for residents are kept locked and inaccessible to other residents. Medication is properly labeled and are centrally stored in a locked cabinet and are in their original containers. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. The last Fire/Emergency Drill was conducted on 7/1/26. Residents with Special Health Need: The residents who are on hospice and have a complete hospice care plan maintained at the facility. There are currently 3 residents using hospice services at this time. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during todays visit. Exit interview was held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2026

Allegation investigated: Staff left resident soiled overnight.

Licensing Program Analysts (LPAs) Tena Herrera and Gabriela Castro conducted an unannounced complaint visit to investigate the above allegation. LPAs met with Jennifer Bobodilla and explained the purpose for todays visit. The investigation consisted of the following: LPAs obtained copies of staff and client rosters, documents within Resident #1's (R1) file that include: Physician Report and Home Heath Plan. LPAs interviewed 3 Staff (S1-S3) and 6 Residents (R1-R6). (Continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff left resident soiled overnight. It is alleged that R1 was left soiled and dirty by facility night staff. LPAs checked supplies for incontinence care and observed a sufficient supply within the facility and extra supplies in the detached garage. LPAs reviewed R1’s physician report and Home Health Care Plan, and it was noted that R1 uses a condom catheter that they are able to drain themselves. LPAs interviewed 3 staff and each denied the allegation and stated that R1 does not use diapers or require caregivers to provide incontinence care as R1 uses a condom catheter that they are able to drain themselves. LPAs interviewed a total of 6 residents and 5 out of 6 residents denied the above allegation and stated that they do need the use of incontinence care and staff provides the required care for them, last rounds are done around 9pm and they are provided with an overnight, extra absorbent diaper and a bed pad, and the first round the next morning by 7am. 5 out of 6 residents stated they had not issues or concerns when in regards to their incontinence care needs. Based on statements and interviews conducted with staff/residents, and review of R1's file, there was not enough supportive evidence to concur with the reported allegation. 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. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 8, 2025 · control 28-AS-20251204140218

Allegation investigated: Licensee is retaining a resident with a higher level of care need. Licensee is not ensuring that resident's medical needs are being met while in care.

Licensing Program Analyst (LPA) Alberto Lopez made initial visit to investigate the above allegations. LPA met with Administrator Jennifer Bobadilla and discussed the purpose of the visit. The investigation consisted of LPA taking tour of facility, obtaining and reviewing staff and resident rosters, R1 Face sheet, Physicians Report for the elderly dated 02/20/2025, and admission agreement. LPA reviewed needs and services and asked facility to send LPA a copy. The investigation revealed regarding allegation: Licensee is retaining a resident with a higher level of care need. It is alleged that facility is retaining R1 that requires a higher level of care. LPA interviewed eight (8) residents and seven (7) of eight (8) residents could not corroborate the allegation. LPA interviewed four (4) staff and three (3) of four (4) staff denied the allegation. R1 stated that R1 gets good care, that R1 room and bed are changed and R1 gets food and R1 body and hair are kept clean. R1 stated that R1 is just tired of being at facility and would like to go to live with ralative. R1 stated R1 has no issues with facility. R1 stated R1 does not need higher level of care. (continued on 9099C) Unsubstantiated (continued from 9099) LPA reviewed R1 Physicians report, and it does not show R1 needing higher level of care. R1 stated she sees fine, not blurry and can read without glasses. There is insufficient evidence to support this allegation. Allegation: Licensee is not ensuring that resident's medical needs are being met while in care. It is alleged that facility is not providing client access for dental, and vision care. LPA interviewed eight (8) residents, and seven (7) of eight (8) residents could not corroborate the allegation. LPA interviewed four (4) staff, and all four (4) staff denied the allegation. Several staff stated that they provide for R1 needs. Staff stated that if R1 requires dental or optometrist visit, that they help arrange it for R1. Staff stated that responsibility would fall on the power of attorney (POA). However, admission agreement shows that facility would assist R1 with assistance in meeting necessary medical and dental appointments. Facility would encourage responsible party to transport R1 but would transport if responsible party is not available. R1 has not gone to see a dentist since R1 was admitted seven (7) years ago but staff stated dentist made home visit about two (2) years ago. R1 stated to LPA that R1 does not want to see a dentist now and R1 will let facility know when R1 wishes to see dentist. R1 stated R1 has no pain, discomfort or sensitivity to cold and hot liquids at this time. LPA reviewed R1 physician’s report, and it does not show that R1 needs glasses. R1 stated R1 sees fine, not blurry and can read without glasses. R1 has right to refuse dental services. There is insufficient evidence to support this allegation. Based on statements and interviews conducted with staff and residents, tour of facility and review of facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 20, 2025 · control 28-AS-20251016133034

Allegation investigated: Staff yelled at resident. Staff threatened resident. Staff requested resident to turn off oxygen tank. Staff refused to provide care to resident.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Administrator Jennifer Bobadilla and the purpose for the visit was explained. The invstigation consisted of the following: LPA obtained copies of staff and client rosters, toured facility, gathered documents within Resident #1's (R1) file that are relevant to complaint, interviewed 4 Staff (S1-S4) and 5 Residents (R1-R5). The investigation revealed the following: (Continued on LIC9099-C) Unsubstantiated Allegation: Staff yelled at resident. It is alleged that S1 yelled at R1 while R1 was yelling in pain. LPA interviewed 5 Residents and each denied the above allegation, interview with R1 resident stated they have never been yelled at by staff. LPA interviewed 4 staff and each denied that allegation, staff stated that they have never yelled at residents or witnessed other staff do this, S1 stated that they have never yelled at any of the residents. Allegation: Staff threatened resident. It is alleged that S1 threatened to evict R1. LPA interviewed 5 residents and each denied the above allegation and stated that they have never been threatened or issued an eviction notice. Interview with R1, resident stated that there was a letter of rent increase discussed but has been decided to not go in effect. LPA interviewed 4 staff and each denied the above allegation and stated that they have never threatened a resident or heard other staff doing this. Interview with S1, staff stated that they did discuss a rent increase due to change of condition and more care needed with R1, however, it has been decided not to proceed with the rent increase. Allegation: Staff requested resident to turn off oxygen tank. It is alleged that staff have asked R1 to turn off their oxygen tank to avoid the high cost of electricity use ongoing. LPA toured facility and observed that facility is equipped with solar panels. LPA interviewed 5 residents and each denied the allegation, interview with R1 resident stated that they are able to have their oxygen tank on when they wish and sometimes have to double check that it is on as they sometimes accidentally turn it off. LPA interviewed 4 staff and each denied the above allegation and stated that they have never asked any of the residents to turn off their oxygen tanks or any kind of medical equipment or TV’s. Allegation: Staff refused to provide care to resident. It is alleged that S1 has told other staff not to tend to R1. LPA interviewed 5 residents and each denied the above allegation and stated that they are provided care whenever needed. Interview with R1, resident stated that they have never been refused care or have overheard staff telling each other not to provide care. LPA interviewed 4 staff and each denied the above allegation, staff stated there may be times where they have to ask the resident to wait as they are tending to others but have never refused to provide care. Interview with S1 staff stated they have never refused care or instructed staff to refuse care to R1 or any other resident, S1 explained that there are certain medications that R1 takes and requests and has told staff to wait the amount of hours needed between doses as this is what the physicians instructions. - Based on statements and interviews conducted with staff and residents, tour of facility and review of facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was emailed.the state’s words, verbatim · CDSS document, Sep 30, 2025 · control 28-AS-20250925233558

Type of visit: Required - 1 Year

Licensing Program Analyst's (LPAs) Tena Herrera and Gaby Castro conducted the required annual inspection. LPA arrived unannounced and met with Jennifer Bobadilla (Administrator/Caregiver) the purpose of today’s visit was explained. The facility is licensed to serve 15 residents age 60 and above. (11) may be non-ambulatory and (4) bedridden. Facility is approved for 4 hospice residents. The facility is located in Bellflower, CA. A tour of the facility includes: 9 bedrooms, 1 staff bedroom, 2 full bathrooms, 1 ½ bathroom, 1 staff bathroom, living room, dining room, kitchen, office area, laundry room, back yard with shaded area, detached garage and a detached shed. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility maintains the required Infection Control Plan. Operational Requirements: Facility maintains the required liability insurance that expires 5/16/26. Physical Plant & Environment Safety: Smoke detectors and carbon monoxide detectors are operable and in compliance. Bathrooms are clean and operational. All residents’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. The outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available to the residents. The hot water temperature was tested throughout the facility and was within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are stored in a secured/locked area and inaccessible to residents. The fire extinguishers were observed and is fully charged. Facility has telephone service on premises. There is a sprinkler system approved by the fire marshal throughout the facility. (Continued on 809-C) Staffing: There appears to be sufficient staffing at all times in the facility with at least one CPR trained employee on the premises at all times. Assistant Administrator Jennifer Bobadilla certificate expires 3/26/26. Personnel Records-Training: Staff has criminal record clearance, current first aid and CPR, Dementia Training, Hospice Training, and ongoing training. Staff files are maintained at the facility and kept in a locked cabinet within the office area. During todays visit LPA's observed 4 staff files with no issues. Resident Records-Incident Reports: Resident files are kept in a secure location within the staff office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Those on Hospice have the required information and documentation. LPA observed 6 resident files during todays visit with no issues. Resident Rights-Information: Complaint, Personal Rights and Ombudsman posters were observed in dining area. Residents are provided with telephone at the facility. Planned Activities: There is an activity schedule posted in the dining area. There are board games, books and daily newspaper readily available for residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Extra food is stored in detached garage. Incidental Medical & Dental: All medications for residents are kept locked and inaccessible to other residents. Medication is properly labeled and are centrally stored in a locked cabinet and are in their original containers. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. The last Fire/Emergency Drill was conducted on 7/13/25. Residents with Special Health Need: The residents who are on hospice and have a complete hospice care plan maintained at the facility. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during todays visit. Exit interview was held and a copy of the report was provided Administrator Jennifer Bobadilla.the state’s words, verbatim · CDSS document, Sep 23, 2025

Allegation investigated: Staff coerced resident in receiving hospice care.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegation. LPA was greeted by Champa (caregiver) and the reason for the visit was explained, shortly after Administrator Jennifer Bobadilla arrived to assist with the visit. The investigation consisted of the following: LPA obtained copies of staff and client rosters, documents within Resident #1's (R1) file that are relevant to complaint, interview with Administrator, Witness #1 (W1), and 3 Residents. (Continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff coerced resident in receiving hospice care. It is alleged that staff have persuaded R1 in signing up with hospice care and they did so unwillingly. LPA interviewed Administrator and it was explained that R1 did give some push back on enrolling into hospice care but after speaking with family and R1 it was determined hospice care was the best fit for R1. Administrator confirmed that alternatives were also provided to R1 but ultimately R1 decided to be admitted to facility with the hospice care services. LPA interviewed W1 and it was confirmed that all information and alternatives were provided to R1 and although R1 was not happy about signing up for hospice services they ultimately decided to sign up on their own. LPA interviewed R1 and R1 stated that although they are not happy about signing up for hospice care they understand why it was suggested and fit for them. LPA interviewed 2 additional residents whom receive hospice care and both denied the above allegation, stating they willingly signed up for hospice and had no influence from staff on their decision. Based on statements and interviews conducted with staff and residents, and review of resident files, there was not enough supportive evidence to concur with the reported allegation. 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. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2025 · control 28-AS-20250321151323

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Jennifer Bobadilla (Administrator/Caregiver) the purpose of today’s visit was explained. The facility is licensed to serve 15 residents age 60 and above. (11) may be non-ambulatory and (4) bedridden. Facility is approved for 4 hospice residents. The facility is located in Bellflower, CA. A tour of the facility includes: 9 bedrooms, 1 staff bedroom, 2 full bathrooms, 1 ½ bathroom, 1 staff bathroom, living room, dining room, kitchen, office area, laundry room, back yard with shaded area, detached garage and a detached shed. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and an Infection Control Plan. Operational Requirements: The facility maintains a plan of operation with the required Dementia Information and Training. Facility maintains the required liability insurance. Physical Plant & Environment Safety: Smoke detectors and carbon monoxide detectors are operable and in compliance. Bathrooms are clean and operational. All residents’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. The outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available to the residents. The hot water temperature was tested throughout the facility and was within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are stored in a secured/locked area and inaccessible to residents. The last Fire/Emergency Drill was conducted on 6/01/2024. The fire extinguishers were observed and is fully charged. Facility has telephone service on premises. There is a sprinkler system approved by the fire marshal throughout the facility. (Continued on 809-C) Staffing: There appears to be sufficient staffing at all times in the facility with at least one CPR trained employee on the premises at all times. Administrator Simla Mehta certificate expires 11/13/2025. Personnel Records-Training: Staff has criminal record clearance, current first aid and CPR, Dementia Training, Hospice Training, and ongoing training. Staff files are maintained at the facility and kept in a locked cabinet within the office area. During todays visit LPA observed 6 staff files with no issues. Resident Records-Incident Reports: Resident files are kept in a secure location within the staff office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Those on Hospice have the required information and documentation. LPA observed 5 resident files during todays visit with no issues. Resident Rights-Information: Complaint, Personal Rights and Ombudsman posters were observed in dining area. Residents are provided with telephone at the facility. Planned Activities: There is an activity schedule posted in the dining area. There are board games, books and daily newspaper readily available for residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Extra food is stored in detached garage. Incidental Medical & Dental: All medications for residents are kept locked and inaccessible to other residents. Medication is properly labeled and are centrally stored in a locked cabinet and are in their original containers. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Residents with Special Health Need: The residents who are on hospice and have a complete hospice care plan maintained at the facility and staff are trained for Hospice Care. All staff files reviewed today also have required training in Dementia and Postural Supports. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during todays visit. Exit interview was held and a copy of the report was provided Administrator Jennifer Bobadilla.the state’s words, verbatim · CDSS document, Aug 5, 2024

Allegation investigated: Unlawful evicition.

**This report supersedes report dated 12/28/2023. The reason it is being superseded is to correct the allegation, as on the original report it was listed as “Staff pushed resident,” when it should have read “Unlawful Eviction.” The finding will remain the same.** Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit regarding the allegation listed above. LPA met with Administrator Jennifer Bobadilla and explained the purpose for the visit. The investigation consisted of the following: During the initial visit conducted on 10/06/2022, LPA Glenn Trueman interviewed Staff #1 - 5 (S1 - S5), Residents #2 - 5 (R2 - R5), and reviewed the file for Resident #1 (R1). During today's visit, LPA Zaragoza re-interviewed Staff #1 - 3 (S1 - S3), obtained the facility's Admission Agreement, House Rules, a Log for residents that sign out of the facility, and Staff Roster. LPA also interviewed Witness #1 (W1) over the phone. LPA attempted to interview R1, however they no longer live at the facility. Unsubstantiated The investigation revealed the following: in regards to the allegation "Unlawful Eviction", it is alleged that R1 was illegally evicted from the facility when R1 was signed out by a friend (W1) for a week, and then refused to be allowed back because R1's bed was already given to a new resident. During interviews with the staff, none of the staff interviewed corroborated the allegation because they all stated that R1 was never evicted, therefore they never issued an eviction notice to R1. One of the staff interviewed explained that R1 stated that they did not want to live in the facility anymore, and signed out of the facility on their own accord with W1 who is a friend. Another staff member interviewed indicated that R1 said they wanted to live with their sibling rather than reside at the facility, and that is why they were signed out of the facility with W1 who is a friend of the family. The staff also explained that after about a week, W1 returned asking to place R1 back in the facility because they were not able to care for R1, however R1's bed was already filled with another resident. LPA obtained the phone number of W1 from the facility administrator and contacted W1 by phone to interview W1 about the allegation. W1 did recall R1 and confirmed that they are a friend of the R1's family, however W1 stated that they did not recall R1 being illegally evicted from the facility. Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 4, 2024 · control 28-AS-20220930100817

Allegation investigated: Unlawful evicition

Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit regarding the allegation listed above. LPA met with Administrator Jennifer Bobadilla and explained the purpose for the visit. The investigation consisted of the following: During the initial visit conducted on 10/06/2022, LPA Glenn Trueman interviewed Staff #1 - 5 (S1 - S5), Residents #2 - 5 (R2 - R5), and reviewed the file for Resident #1 (R1). During today's visit, LPA Zaragoza re-interviewed Staff #1 - 3 (S1 - S3), obtained the facility's Admission Agreement, House Rules, a Log for residents that sign out of the facility, and Staff Roster. LPA also interviewed Witness #1 (W1) over the phone. LPA attempted to interview R1, however they no longer live at the facility. The investigation revealed the following: in regards to the allegation "Staff pushed resident", it is alleged that R1 was illegally evicted from the facility when R1 was signed out by a friend (W1) for a week, and then refused to be allowed back because R1's bed was already given to a new resident. Unsubstantiated During interviews with the staff, none of the staff interviewed corroborated the allegation because they all stated that R1 was never evicted, therefore they never issued an eviction notice to R1. One of the staff interviewed explained that R1 stated that they did not want to live in the facility anymore, and signed out of the facility on their own accord with W1 who is a friend. Another staff member interviewed indicated that R1 said they wanted to live with their sibling rather than reside at the facility, and that is why they were signed out of the facility with W1 who is a friend of the family. The staff also explained that after about a week, W1 returned asking to place R1 back in the facility because they were not able to care for R1, however R1's bed was already filled with another resident. LPA obtained the phone number of W1 from the facility administrator and contacted W1 by phone to interview W1 about the allegation. W1 did recall R1 and confirmed that they are a friend of the R1's family, however W1 stated that they did not recall R1 being illegally evicted from the facility. Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 28, 2023 · control 28-AS-20220930100817

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Jennifer Bobadilla (Administrator/Caregiver) and Simla Mehta (Administrator/Licensee) and explained the purpose of today’s visit. The facility is licensed to serve 15 residents age 60 and above. 11 may be non-ambulatory and 4 bedridden. Facility is approved for 4 hospice residents (currently only 1 resident is on hospice). The facility is located in Bellflower, CA. A tour of the facility includes: 9 bedrooms, 1 staff bedroom, 2 full bathrooms, 1 ½ bathroom, 1 staff bathroom, living room, dining room, kitchen, office area, laundry room, back yard with shaded area, detached garage and a detached shed. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and an Infection Control Plan. Operational Requirements: The facility maintains a plan of operation and has the required liability insurance on file. Physical Plant & Environment Safety: Smoke detectors and carbon monoxide detectors are operable and in compliance. Bathrooms are clean and operational. All residents’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. The outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available to the residents. The hot water temperature was tested in two resident bathrooms and measured between 113.3-114.2 degrees F which is within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are stored in a secured/locked area and inaccessible to clients. The last Fire/Emergency Drill was conducted on 7/10/2023. The fire extinguishers were observed and is fully charged. Facility has telephone service on premises. There is a sprinkler system approved by the fire marshal throughout the facility. During todays visit LPA observed the opening to crawl space was not covered in two separate locations, details will be cited on 809D page. (Continued on 809-C) Staffing: There appears to be sufficient staffing at all times in the facility with at least one CPR trained employee on the premises at all times. Administrator Simla Mehta certificate expires 11/13/2023. Personnel Records-Training: Staff has criminal record clearance, current first aid and CPR, and ongoing training. Staff files are maintained at the facility and kept in a locked cabinet within the office area. During todays visit LPA observed 5 staff files with no issues. Resident Records-Incident Reports: Resident files are kept in a secure location within the staff office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. LPA observed 5 resident files during todays visit with no issues. Resident Rights-Information: Complaint, Personal Rights and Ombudsman posters were observed in dining area. Residents are provided with telephone at the facility. Planned Activities: There is an activity schedule posted in the dining area. There are board games, books and daily newspaper readily available for residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: All medications for residents are kept locked and inaccessible to other residents. Medication is properly labeled and are centrally stored in a locked cabinet and are in their original containers. During the visit today, LPA reviewed 5 residents medications 1 out of the 5 residents had a medication that did not match what is listed on the doctors medication list, details will be cited on the 809D page. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Residents with Special Health Need: There is currently 1 resident who is on hospice and has a complete hospice care plan maintained at the facility. LPA conducted 3 staff interviews and 2 client interviews during today’s visit. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit is documented on 809D. Exit interview was held and a copy of the report was provided Administrator Jennifer Bobadilla.the state’s words, verbatim · CDSS document, Oct 28, 2023