Steeplechase Villa

Allegation investigated: Facility did not ensure a comfortable temperature was maintained for residents. Staff member worked while under the influence of marijuana, impairing their ability to provide adequate care.

On 05/18/2026 at 3:14PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to deliver findings for the above allegations. LPA met with Kimberly Whittle, Administrator, and explained the purpose of the visit. Allegation: Facility did not ensure a comfortable temperature was maintained for residents. Facility did not ensure a comfortable temperature was maintained for residents Interview with S1 revealed the temperature is set at 72 degrees daily and staff have the ability to adjust the temperature if they need to. Interview with S1 also revealed the facility’s temperature is maintained through an application called Google Nest a system which allows Administrator to monitor and control the temperature remotely. Continues on LIC9099C.... Unsubstantiated Continues from LIC9099 Interview with W1 revealed the temperature at the facility is normally set to 51 degrees everyday causing the residents to complain of being cold. Interviews with R1, R2 and R3 revealed the temperature is okay at the facility. Interviews with R1 and R3 revealed they both get cold at times; staff will give them a throw blanket and then they’re okay. Record review revealed facility’s temperature was maintained between 72 degrees to 74 degrees throughout the Month of January 2026. Allegation: Staff member worked while under the influence of marijuana, impairing their ability to provide adequate care and supervision, which presents a risk to residents in care Interviews with S1 revealed facility staff have not mentioned to S1 about staff member smelling like marijuana or any staff members being under any influence while providing care. Interview with S1 also revealed facility would take the proper steps to terminate anyone who is working under the influence of alcohol or drugs. Interview with W1 revealed that staff member came to work smelling like marijuana and could not perform work duties. Interview with W1 also revealed residents complained to W1 about staff member smelling like marijuana. Interview with S2 revealed facility has a zero policy regarding drugs and alcohol. Interview with S2 also revealed S2 hasn’t witnessed or heard of any staff members smelling like marijuana. Interviews with R1, R2 and R3 revealed residents have not witnessed any of the staff being under the influence of marijuana or the smelling like marijuana when providing care. 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 conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 18, 2026 · control 15-AS-20260123160633

Allegation investigated: Not enough staff to care for residents. Lack of food and moldy food.

On 05/18/2026 at 2:17PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to deliver findings for the above allegations. LPA met with Kimberly Whittle, Administrator and explained the purpose of the visit. Allegation: Not enough staff to care for residents Interviews with S1, S2 and S3 revealed the facility’s staff schedules overlaps, resulting in two (2) staff members being at facility for a period of time on AM and PM shifts. Interviews with S1, S2 and S3 revealed the night staff prepare breakfast for the residents before end of their shift, allowing the staff on AM shift to start showering, toileting and getting residents dressed for the day. Interviews with R1, R2, and R3 revealed staff arrive within a couple of minutes after their call buttons have been activated. Record revealed, facility has staff sufficient in numbers. Continues on LIC9099C..... Unsubstantiated Continued from LIC9099 Allegation: Lack of food and moldy food. Interviews with S1 and S2 revealed staff cleans refrigerator bi-weekly and removes any food from refrigerator and countertops before food goes bad. Interview with S3 revealed staff provided a small portion of food to the residents in care. Interview with S3 also revealed, S3 witnessed a moldy piece of fruit on the countertop. Interview with R1, R2 and R3 also revealed facility provided a good amount of food and if residents want more food staff will provide residents with more food. LPA toured facility and observed facility to have 7- days of nonperishables and 2- days of perishable foods, fruits and food was in good quality. 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 conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 18, 2026 · control 15-AS-20260102151106

Type of visit: Required - 1 Year

On 05/18/2026 at 10:45AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conducted a 1-year inspection. LPA met with Caregiver Alexis Noblitt. Administrator, Kimberly Whittle, was present during the visit, LPA explained the purpose of visit. Administrator holds certificate # 7031907740 expires on 10/11/2027. Fire clearance was approved for six (6) non ambulatory residents. LPA toured facility with Administrator including but not limited to seven (7) bedrooms, one (1) occupied by staff, four (4) bathrooms, dining area, living room, kitchen, garage, and outdoor area. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. Hot water temperature in the shared residents’ bathroom was measured at 109.8 degrees Fahrenheit. LPA observed residents’ shared bathrooms are equipped with grab bars and non-skid mats. LPA observed there is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. LPA observed the facility has a comfortable room temperature and is maintained at 73 degrees F. Carbon monoxide and smoke detectors were observed in operating condition. The first-aid kit was observed and was complete. Fire extinguisher was observed to be full and last serviced on 09/04/2026. Emergency disaster plan was last posted on 05/01/2026. Last fire drill was conducted on 05/01/2026. Continue on LIC809C Continued from LIC809 LPA reviewed all three (3) residents’ records, and three (3) staff records and they were complete. All staff are fingerprint clear, have FirstAid/CPR and are associated with the facility. LPA also reviewed a sample of medication during visit. The following forms are to be updated and submitted to CCL by 05/25/2026. LIC 500- Personnel Report LIC 308- Designation of Facility Responsibility LIC 610E- Emergency/Disaster Plan (9 pages) Evidence of Liability Insurance No deficiencies observed during visit. Exit interview conducted and a copy of this report provided to Kimberly Whittle.the state’s words, verbatim · CDSS document, May 18, 2026

Type of visit: Post Licensing

On 07/02/2025 at 1:35PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced post licensing inspection. LPA met with Caregiver, Jacqueline Samayoa. Jacqueline contacted the Administrator, Henry Paul Salazar, via telephone and advised the purpose of the visit. The administrator arrived at 2:14PM, LPA explained the purpose of visit. LPA toured facility including but not limited to bedrooms, bathrooms, dining area, living room, kitchen, garage, and outdoor area. The fire extinguisher was observed to be full and last serviced on 04/15/2025. Medications were in a locked cabinet located in the kitchen. Comfortable room temperature is maintained at 76 degrees F. Hot water temperature in the shared residents’ bathroom was measured at 121.4 degrees Fahrenheit. Carbon monoxide and smoke detectors were observed in operating condition. The first-aid kit was complete, and hygiene items for resident general use are sufficient. Extra linens and towels were observed. Last fire drill was conducted on 2/26/2019. There are no accessible bodies of water observed. Continue on LIC809C Continued from LIC809 LPA reviewed all four (4) residents’ records, and two (2) staff records and they were complete. All staff are fingerprint clear, have FirstAid/CPR and are associated with the facility. The following forms are to be updated and submitted to CCL by 07/09/2025: LIC 500- Personnel Report LIC 308- Designation of Facility Responsibility LIC 610E- Emergency/Disaster Plan (9 pages) Evidence of Liability Insurance LPA observed the following deficiencies: At 2:09PM, LPA observed during facility tour, facility does not have 7- days of nonperishables and 2- days of perishables At 3:22PM, LPA observed two (2) out four (4) personnel records were not at the facility during record review. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 2, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Jul 11, 2025

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in not having one week of nonperishables foods and two days of perishables foods, which poses a personal rights risk to person in care.the state’s words, verbatim · CDSS document, Jul 2, 2025

Plan of correction: Administrator agreed to purchase one week of nonperishables and two days of perishables foods and send CCLD an email with photo by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87412(f) · Plan of correction due date: Jul 3, 2025

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours...This requirement was not met as evidence by: Based on observation and record review the Licensee did not comply with the section cited above in having not having S1 and S4 personnel records available to the licensing agency, which poses a health and safety risk to person in care.the state’s words, verbatim · CDSS document, Jul 2, 2025

Plan of correction: Administrator agreed to have personnel records available for licensing agency to inspect during business hours and send CCLD a self-certifying email by the POC date.

Type of visit: Prelicensing

On 05/06/2025 at 2:15PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection. This is a continuance from the previous visit conducted on 04/24/2025. LPA met with Paul Henry Salazar and Jan Jocson, Licensee/Administrator and explained the purpose of the visit. On 04/29/2025 at 10:03 AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted a Pre-licensing Inspection. LPA met with Licensee/Administrator, Paul Henry Salazar and explained the purpose of the visit. LPA toured facility including but not limited seven (7) bedrooms, one (1) bedroom occupied by staff, four (4) bathrooms, one (1) occupied by staff, living room, dining area, kitchen, garage, and outdoor area. LPA observed lighting in all rooms. LPA observed facility had some non-perishable food supply. Licensee will purchase additional food supplies once facility is licensed. Carbon monoxide and smoke detectors was observed in operating condition. First aid kit was complete. Fire extinguisher was last purchased on 12/18/2024. Facility inspection matches the sketch that was provided. Continue on LIC809C Continued from LIC809 LPA observed Licensee/Administrator made corrections from previous visit on 04/29/2025. LPA Conducted COMP III on 05/06/2025. The licensee/administrator was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first resident. This notification may be done by phone, by mail, email, or by fax. No Issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 6, 2025

Type of visit: Case Management - Other

On 05/06/2025 at 2:41PM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived to conduct an announced Case Management COMP III visit. LPA met with Paul Henry Salazar and Jan Jocson, Administrator/Licensee and explained the purpose of the visit. LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participants gained knowledge about running and maintaining the facility in accordance with regulations. A license has not yet been granted to this facility. Licensure is subject to final review and approval by the Centralized Applications Unit. Licensee is not to accept consumers until notified by Community Care Licensing that the license has been approved. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 6, 2025

Type of visit: Prelicensing

On 04/29/2025 at 10:03 AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted a Pre-licensing Inspection. LPA met with Licensee/Administrator, Paul Henry and explained the purpose of the visit. LPA toured facility including but not limited to resident's bedrooms, bathrooms, living room, dining area, kitchen, garage, and outdoor area. LPA observed lighting in all rooms. LPA observed facility had some non-perishable food supply. Licensee will purchase additional food supplies once facility is licensed. Carbon monoxide and smoke detectors was observed in operating condition. First aid kit was complete. The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB): 1.)LPA observed facility does not have a professionally installed grab bars in all three (3) showers in residents’ shared restroom. Continue on LIC809C Continued from LIC809 2.) LPA observed facility does not have complete bedding for all six bedrooms, beds are missing mattress pads and blankets. 3.) LPA observed facility does not have an exit sign in the backyard identifying emergency exit. 4.) LPA observed facility does not have a dementia plan and observed the plan does not address behaviors such as ingestion of toxic chemicals and wandering behaviors. 5.) LPA observed facility does not have PUB 475 20x26 and Ombudsman poster. 6.)LPA observed facility does not have emergency disaster plan (9 pages) posted. Comp III will be conducted during follow-up visit. Licensee/Applicant will submit proof of corrections to CCLD on/before 05/06/2025. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 29, 2025

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.