The Olive House

Type of visit: Required - 1 Year

At approximately 10:30 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Anya Balaoy, Administrator was contacted via telephone and arrived at approximately 11:00 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. Facility has a Dementia Care Plan, is approved for all non-ambulatory residents, and has a Hospice waiver for three (3). LPA and Administrator first followed up on a death report received by the department 04/30/2026 by contacting the Emergency Medical Services (EMS) company that responded to the call for service on 04/25/2026 for Resident 1 (R1) to get information on the process for requesting a copy of the EMS report. At approximately 12:00 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA observed egress devices activated on all facility doors. Water temperatures in the residents' bathrooms tested within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. However, LPA observed each residents' medications pre-poured into weekly pill containers. LPA informed Administrator that medications shall not be pre-poured or transferred into another container per regulations. Continued on LIC809-C... Continued from LIC809... Administrator conveyed understanding, returned all medications to their original prescription containers, agreed to conduct an all staff in-service on medication management regulations and protocols immediately, and agreed to ensure the facility operates in compliance with regulations moving forward. Smoke and carbon monoxide detectors were tested and operational during inspection. Fire extinguisher was observed fully charged and was last inspected 07/2026. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed residents watching TV, gathered for meals, and engaged in TV lead exercises in the common area of the facility during inspection. Facility has coloring supplies and games for residents. Facility has internet service and has an internet access device designated for resident use. The telephone was tested and was operational during inspection. Emergency Disaster Plan was reviewed and updated 07/2026. Facility conducts quarterly disaster drills with the most recent drill conducted 07/2026. At approximately 1:15, LPA conducted file review of three (3) staff files and observed the following: Three (3) of three (3) staff files reviewed have the required paperwork and proof of all of the required initial medication training, annual medication training, and annual training hours per regulation. Three (3) of three (3) staff files reviewed were observed missing 14 hours of their required initial 40 hours of training. Administrator was provided a copy of the Health and Safety Code 1569.625, conveyed understanding of the requirement, and immediately began communicating with facility's third party training vendor to ensure all staff complete the required outstanding hours to ensure the facility is operating within compliance. LPA observed three (3) of three (3) staff contained proof of the required current first aid and CPR training certifications. At approximately 2:00 PM, LPA conducted file review of four (4) resident files and observed the following: One (1) of four (4) resident files reviewed was observed missing a current LIC602 and updated appraisal needs and services plan a required per regulation for residents with dementia. Administrator immediately contacted the resident's responsible party to schedule an appointment with the resident's primary care physician to have this updated. Four (4) of four (4) resident files reviewed contained all of the remaining required paperwork per regulation. Continued on LIC809C... Continued from LIC809C... At approximately 3:45, LPA conducted a review of medications and medication records which were observed stored and maintained in accordance with regulation. Facility assists with coordinating medical and dental appointments as well as transportation to and from appointments when residents have the need. Facility does not manage P&I cash resources for residents. Exit interview conducted with Administrator whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 17, 2026

Allegation investigated: Facility did not give proper notice for level of care rate change

On 09/23/2025, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver complaint #21-AS-20250617144049 investigation findings regarding the above allegation and met with Xiomara Robles, Licensee. Reporting Party (RP) alleges that the facility did not give proper notice for level of care rate change for Resident 1 (R1). LPA Florio conducted 10-day complaint investigation visit on 06/19/2025 and obtained documents, made observations, and conducted interviews. During this visit, it was revealed through an interview with Licensee and through R1's updated appraisal needs and services plan dated 05/22/2025 that R1's care needs increased significantly from those intially reported by R1's family during the initial pre-placement appraisal and those indicated on R1's LIC602 Physcian's Report dated 04/15/2025 -- both reported occasional wandering and aggression, which facility staff later experienced as around the clock, everyday behaviors requiring inreased supervision of R1 and increased staffing needs. Continued on LIC9099C... Unsubstantiated Continued from LIC9099... Subsequently, on 09/19/2025, LPA received copies of R1's admissions agreement dated 04/18/2025 and R1's admissions agreement addendum from Licensee which were sent to R1's responsible party via DocuSign on 05/31/2025 with the rate increase effective 06/01/2025. This addendum explained the change in condition and supervision needs of R1 noting changes in their sleeping patterns and daily and nightly elopement attempts. On 09/19/2025, LPA also received forwarded email communications dated 05/30/2025 between Licensee and R1's responsible party regarding a previous 30-day notice submitted by R1's child on May 1, 2025 via text message and the rate change with explanation should R1 remain in the facility. Based on observations made, interviews conducted, and records reviewed, the department received conflicting information. Based on interviews conducted and records obtained, the allegation that facility did not give proper notice for level of care rate change for R1 is UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited. Exit interview conducted with Licensee, whose signature on form confirms receipt of document(s).the state’s words, verbatim · CDSS document, Sep 23, 2025 · control 21-AS-20250617144049

Type of visit: Case Management - Annual Continuation

At approximately 2:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Case Management - Annual Continuation inspection and was greeted by staff. LPA met with Xiomara Robles, Licensee and Anya Balaoy Licensee/Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with one (1) resident in care. Facility has a Dementia Care Plan and is approved for all non-ambulatory residents. At approximately 2:10, LPA conducted file review of three (3) staff files and one (1) client file and observed the following: Three (3) of three (3) staff files reviewed have the required paperwork and proof of inital and annual training hours per regulation. Two (2) of three (3) staff have proof of the required current first aid training certification. Licensee understands that first aid is a minimum requirement for all care staff and agrees to have Staff 2 (S2) complete their first aid training prior tho their next shift. The one (1) client file reviewed was missing the emergency ID form, personal rights form, and the consent for emergency medical treatment. LPA explained the required documentation to Licensee who conveyed an understanding and agreed to bring the facility into compliance with regulation. At approximately 3:10, LPA conducted a review of medications and medication records which were observed stored and maintained in accordance with regulation. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC610E - Emergency Disaster Plan Exit interview conducted with Licensee whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 23, 2025

Type of visit: Required - 1 Year

At approximately 3:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Xiomara Robles, Licensee was contacted via telephone and arrived at facility at approximately 3:15 PM. Archebal A. Balaoy, Administrator/Licensee arrived at approximately 3:30 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with one (1) resident in care. Facility has a Dementia Care Plan, is approved for all non-ambulatory residents. At approximately 3:20 PM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA observed egress devices activated on all facility doors. Licensee agrees to ensure water temperatures test within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed resident watching TV in the common area of the facility during inspection. Facility has coloring supplies and games for residents. Facility has internet service and agrees to obtain an internet access device designated for resident use. The telephone was tested and was operational during inspection. Smoke and carbon monoxide detectors were tested and operational during inspection. Fire extinguisher was observed fully charged and was last inspected 07/2025. Continued on LIC809-C... Continued from LIC809C... Emergency Disaster Plan was reviewed and updated 05/2024. Facility conducts monthly disaster drills with the most recent drill conducted 06/2025. Facility assists with coordinating medical and dental appointments as well as transportation to and from appointments when residents have the need. Facility does not manage P&I cash resources for residents. LPA will return at a later date to complete staff, client, and medication file review. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC610E - Emergency Disaster Plan Proof of Liability Insurance Proof of control of property - Current Lease Agreement Exit interview conducted with Licensee whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 22, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) J. Macias arrived announced at approximately 09:00am to conduct a pre-licensing inspection and was greeted by Applicant, Anya Balaoy. Facility currently does not have residents in care. Administrator certificate for applicant Anya Balaoy Certificate 6070875740 expires on 06/09/2026. Once obtained, applicant will submit proof of required liability insurance. The facility received a fire clearance approval on 5/8/2024 by the County of Napa Fire Prevention Division Office for six [6] non-ambulatory residents .Applicant has submitted a required infection control plan, and a required emergency & disaster plan as part of their application packet. At approximately 9:30am LPA and Applicant toured the building and grounds. The facility was found to be at a comfortable temperature. The facility consists of a single story residence with a total of 4 bedrooms, 2 full bathrooms, which one is located in the master bedroom. There was sufficient lighting throughout the facility in resident rooms, common areas, bathrooms, and hallways. No bodies of water. No firearms. All bathrooms had grab bars and non skid mats for resident use. Laundry room located in the garage, kitchen, dining room, and living room as common areas. Facility has a sufficient supply of food, perishable and non-perishable. LPA observed sufficient supply of cleaners, paper products, hygiene products, and personal protective equipment (PPE). All resident rooms are furnished per regulation with a bed, lamp, and bedside table. Cleaning supplies will be stored in a secured cabinet located underneath the kitchen sink.The facility does have emergency food supplies, and emergency supplies, to meet the "72 hour shelter in place" requirements. Hot water was measured at 119.1 and 117.1 degrees Fahrenheit, which is within regulation of 105 and 120 degrees F. All exits were unobstructed in the home. All exit doors had auditory alarms and the alarms were working properly during the inspection. Fire extinguisher was serviced and tagged as required with a date of April 29, 2024. There are six (6) smoke alarms that are dual carbon monoxide detectors and were all working appropriately. Continued on LIC809C... Continued from 809... Postings noted to be current and in compliance with regulations. There is a sign in and sign out log at the front door. All postings required were posted, and visible upon entry into the facility and during the facility tour. LPA conducted a component III orientation with Applicant Anya Balaoy. Pre-Licensing is complete and this facility has no apparent hazards to health and safety observed by the inspecting LPA, today, 8/5/2024. Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulation. LPA will notify Application Unit Pre-licensing inspection is complete to proceed with the process of license. No deficiencies cited at today’s inspection. Exit interview conducted with Applicant and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 5, 2024

Type of visit: Office

Facility Type: RCFE Application Type: INTL Capacity: 6 Census : 0 Method: Telephone call with CAB COMP II Participants: Anya Balaoy (Administrator/Licensee) & Tammy Edwards (Analyst). Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee's understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 8, 2024