Tess Loving Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility to conduct an Annual Required Evaluation. LPA was greeted and granted entry by staff at 12:30pm. LPA met with Administrator Marites "Tess" Villanueva and explained the purpose of the visit. The facility is a single story, five bedroom, two bathroom residential home with an approved fire clearance of six non-ambulatory residents with a hospice waiver for six residents. Currently there are four residents in care and none of the residents receive hospice services. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. Staff trainings were current and documented. The administrator has a current administrator's certificate which expires on December 12, 2027. The facility has liability insurance and the Emergency Disaster Plan was reviewed and initialed. Licensing fees are current and the See Something, Say Something and Long Term Care Ombudsman posters were posted in a prominent area. During the visit, LPA toured the facility and inspected carbon monoxide and smoke detectors. The carbon monoxide and smoke detectors were operational. The facility was 73 degrees Fahrenheit and there were no odors detected. The fire extinguisher was charged and inspected on June 23, 2026. The facility's last fire and heat drill was conducted on July 10, 2026. LPA observed the sharps and knives were secured in a locked cabinet and chemicals were secured underneath the sink. The facility had two days of perishable food items and seven days of non perishable food items on site. A weekly food menu was observed on the refrigerator. All kitchen appliances and washer and dryer were in working order. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured resident bedrooms and observed residents had the required furnishings, and clean linens. LPA tested the hot water temperature in two of two resident bathrooms and the hot water temperature ranged from 114.2 to 114.4 degrees Fahrenheit. Bathrooms had grab bars and non-skid flooring and hygiene items were secured beneath the sink. LPA toured the detached garage which is used for storage and walked the exterior of the property. There is ample space for outdoor activities and there were no hazards or obstructions in pathways. A shaded seating area was available and the exterior gate is self-latching. LPA observed emergency supplies and water for the residents. LPA attempted to interview two of four residents. Two residents were sleeping after lunch, and two residents were unable to communicate but appeared dressed and clean. LPA interviewed two of two staff members regarding care provided. LPA observed secured medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid kit had the required elements and the Administrator purchased a First Aid Manual for the facility. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Marites Villanueva, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Aug 6, 2026

Allegation investigated: Resident sustained multiple wounds in care due to neglect by facility staff. Facility staff did not seek medical attention for resident in timely manner. Facility retained a resident beyond their level of care.

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Staff #1 (S1) at 1pm. LPA met with Administrator (AD) Marites "Tess" Villanueva and explained the purpose of the visit. LPA obtained the following documentation for Resident #1 (R1): Physician's Report dated June 21, 2021, Resident Appraisal, Identification and Emergency Information and Admission Agreement. Resident had a diagnosis of dermatitis and required wound care and came from a Skilled Nursing Facility (SNF). The Resident Appraisal dated June 21, 2021 notes that R1 had superficial wounds all over the body due to dermatitis. R1 was bed bound and non-ambulatory with mild cognitive impairment. LPA reviewed hospice paperwork for R1. R1 initially came to the facility on hospice care on June 23, 2021 from a SNF but was discharged on March 29, 2022. On August 2, 2022, the facility contacted hospice due (Continued on LIC 9099-C) Unfounded (Continued from LIC 9099) to non healing wounds and R1 began receiving hospice services and had a wound specialist that visited two times per week starting on August 2-29, 2022. Hospice continued to monitor and the hospice nurse asked the medical director for assessment. Hospice requested R1 be sent to the hospital on August 29, 2022. LPA reviewed hospital discharge paperwork from August 29, 2022. Paperwork stated, R1, "...has had a long term history of non healing wounds due to severe dementia and functional quadriplegia. The wounds have been worsening to the point where her boarding care feels that they are unable to care for them. She was subsequently referred to the emergency department for evaluation." The principal problem, per hospital paperwork, was sepsis. R1 returned to the facility on September 2, 2022 and received hospice services. Resident passed away on September 4, 2022 at the facility. LPA interviewed two of two staff members who both recalled the incident. Two of two staff denied all of the allegations. LPA interviewed two of two witnesses. Both witnesses denied all of the allegations. Based on LPA's observations, record review and interviews the allegations that: Resident sustained multiple wounds in care due to neglect by facility staff, Facility staff did not seek medical attention for resident in timely manner and Facility retained a resident beyond their level of care are Unfounded. The allegations are false, could not have happened, and/or are without a reasonable basis. An exit interview was conducted with Administrator, Marites "Tess" Villanueva and a copy of this report and LIC 811, were provided to the facility.the state’s words, verbatim · CDSS document, Jan 12, 2026 · control 22-AS-20220907150650

Type of visit: Required - 1 Year

On October 7, 2025, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty notified the facility administrator (AD) Marites Villanueva about the visit. For this visit, there are two staff members on duty, both of which are background cleared and associated. Designee Soledad Larcia, assisted with the inspection. The PUB475 ‘See Something, Say Something’ poster was observed to be located by the front entrance. LPA observed the Administrator's Certificate for Marites Villanueva, which expires on December 12, 2025. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, none of which may be bedridden, and all of which may be on hospice. LPA toured the interior and exterior portions of the facility with Designee. For this visit, there are a total of four non-ambulatory residents in care and none are on hospice. The facility is a single-story home. There are a total of five bedrooms, two are private resident rooms, two are shared resident rooms, and one serves as staff quarters. LPA toured each bedroom with the Designee and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the staff quarters to be kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested. Auditory exit alarms were operational. However, LPA observed that the carbon monoxide alarm only had two batteries when three are necessary for it it operate properly. LPA also observed Staff 2 replaced the smoke detector when it was not working properly during the test. Continued on LIC 809-C. There are a total of two fully functioning bathrooms for residents and staff. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathrooms were measured to be between 106.5 and 108.5 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in the kitchen and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the dining room. Fire extinguisher was dated and tagged on July 11, 2025. LPA observed the emergency disaster and evacuation plan, which is posted near the front entrance. Facility had back-up emergency food and water supply, located in the kitchen pantry. LPA observed that the First Aid kit had all the required components. Medications and toxins were also observed to be locked in a cabinet in the kitchen, inaccessible to residents in care. For the exterior portion, LPA observed patio furniture under shading, and the grounds were free of any hazards or obstructions. There is one self-latching gate in the backyard that can be opened in case of an emergency. No bodies of water were observed. LPA observed the Emergency Disaster Plan binder which did not consist of quarterly emergency drills, as required by California Code of Regulations 1569.695(c). Based on today's observations, there are two deficiencies being cited per Title 22 of the California Code of Regulations. Carbon monoxide and smoke detectors should be in working order at all times and staff shall conduct emergency drills on a quarterly basis. An exit interview was conducted with Soledad Larcia. This report was reviewed with the administrator designee and a copy was provided at the end of the visit. Appeal Right were reviewed.the state’s words, verbatim · CDSS document, Oct 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to conduct the Required 1-Year evaluation. LPA was greeted and granted entry into the facility by Administrator (AD) Marites (Tess) Villanueva and reason for visit was explained. There were 4 residents present during today's visit. The facility is a single story home with an attached garage, four resident bedrooms, two resident bathroom, one staff bedroom, kitchen, dining room and family room. Of the four resident's in care, AD reported only one resident is receiving Hospice services. LPA along with AD conducted a tour of the inside and outside of the facility, and observed the following: LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature. Lighting is sufficient for safety and comfort. LPA observed a table and chairs in covered back patio area for residents and visitors. Bedrooms were observed to be spacious and easily accommodate furnishings such as lamps, chair, dresser and a bed. Bathrooms were observed to be clean, have a supply of soap and paper towels. Hot water temperature was within regulatory requirements. Linen and hygiene supplies were stocked. Emergency Phone Numbers and Exit Plan were reviewed. Food prep area is clean and organized. Food supply meets the requirement of one (1) week supply of non-perishable and two (2) day supply of perishables. Smoke detectors and carbon monoxide detectors were found to be operational. Fire Extinguishers were charged and mounted. Stove burners, dishwasher, microwave, washer, and dryer are operational. Chemicals and sharps are made inaccessible to the residents. Laundry is done in laundry room adjacent to kitchen. LPA verified that Dementia safeguards were in place, such as alarms on exit doors and locked areas for toxins and hazardous items. Medications are centrally stored in a locked cabinet in laundry room. Medications reviewed appear to have been dispensed accurately. LPA interviewed 4 of 4 residents and one staff. Resident and staff files were reviewed. LPA confirmed Administrator has a current Administrator's certificate which expires 12/12/2025. Based on the observations made during today's visit, no deficiencies are being cited. An exit interview was conducted with AD Villanueva and a copy of this report was provided at the end of the visit via email.the state’s words, verbatim · CDSS document, Aug 8, 2024

Allegation investigated: Resident suffered a fall resulting in a fracture.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegation listed above. LPA was greeted and granted entry by caregiving staff after introducing himself and stating the reason for the visit. Administrator Marites Villanueva was notified of the visit via telephone and arrived later to assist. The initial complaint investigation was conducted remotely by LPA Lydia Martinez due to COVID-19 precautionary measures in place at the time. LPA requested copies of facility and resident records which were provided by the facility and received by the Regional Office on November 30, 2020. A subpoena for hospital records was submitted and records were obtained. LPA Saborit-Guasch conducted additional interviews via telephone ahead of the present visit. Resident records were reviewed and two facility staff interviews were also conducted. CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED FROM LIC9099 Regarding the allegation that Resident suffered a fall resulting in a fracture, the following has been concluded: Based on documents reviewed and interviews conducted, it was determined that on November 12, 2020, resident R1 sustained a fall and was later transported to the Emergency Department at UCI Hospital. However, the evidence reviewed did not appear to corroborate any deficiency in the care and supervision provided by facility staff that would have been the cause for the fall and subsequent injury. At the time of the incident, R1 had been assessed to require a walker and was generally using it to ambulate in the facility. The physician report on file for R1 dated December 17, 2019 confirms that the resident was a "high risk for falls" and was being monitored as such. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Dec 7, 2023 · control 22-AS-20201116161730