The Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met Caregiver Issac Kung and explained reason for visit. Administrator David Kim arrived shortly. The facility is licensed to serve 1 Ambulatory Resident and 12 Non-Ambulatory Residents ages 60 and over (of which 6 may be bedridden). Facility has a hospice waiver for 6, there are currently 3 residents using hospice services. The Facility is a single story building located in Downey, CA. A tour of the facility included: 11 resident bedrooms, 7 bathrooms, living room, dining room, tv room, kitchen, laundry room, two (2) shaded patio areas, detached garage and tool sheds used for storage and emergency food supply. LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. Extra linen was observed in laundry room. The Smoke detectors and carbon monoxide detectors were observed throughout the facility and are properly operating. The facility several fully charged fire extinguishers located throughout the facility. Cleaning supplies and toxic substances were observed to be accessible in two bathrooms. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 7 days non-perishable foods and 2-day perishable foods. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were not measured between the required range of 105-120 degrees F. The resident bathrooms have the required grabs bars and non-skid mats. There is a shaded seating area for the residents in backyard. Passageways and exits were not free of obstruction. SEE LIC 809C Five (5) staff files were reviewed and included criminal clearance record, and health screening. Two staff were missing TB readings. Staff was missing required initial and annual training. Five (5) resident files were reviewed and included physician reports and appraisal needs and service plan. Three (3) residents had expired physicians reports. Fire/earthquake drill was conducted in December of 2025. The medications are centrally stored and locked in a cabinet in living room. LPA reviewed medications residents, and they are being administered as prescribed by the physician. Mar log is being used. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was deficiencies observed during the visit (Refer to LIC 809-D). Exit interview held and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 10, 2026

Allegation investigated: Staff handled resident in care in a rough manner

Licensing Program Analysts (LPAs) Luis De Leon and Mary Flores conducted an unannounced complaint investigation visit for the allegation listed above. LPAs met with the Administrator David Kim and explained the reason for the visit. The investigation consisted of the following: On today’s visit, LPAs Flores, and De Leon obtaining resident and staff rosters, resident #1(R1) admission agreements, physician’s report, staff training, needs and service plan, resident appraisal, order summary report staff’s personal right training provided on 11/22/22, 3/18/08, 10/11/17, and 12/29/16. LPAs review four (4) out (4) staff records and R1’s records. LPAs interviewed five (5) out of thirteen (13) residents and four (4) out of (4) staffs. LPA contacted R1’s responsible party over the phone. (Continue on LIC-9099C) Unsubstantiated The investigation revealed the following: Regarding allegation: Staff handled resident in care in a rough manner. It is alleged that, on or around May 3rd, 2025, an individual took a resident into a room, beat the resident, and staff have treating the resident roughly. During residents’ interview, four (4) out five (5) residents stated that staff has treated them with respect and that staff are very nice to residents. Staff interviews revealed that four (4) out of four (4) staff have not been rough to residents. Three (3) out of four (4) staff described providing services to residents and stated that they treat them as if they were family. R1’s responsible party stated that has notice a change of condition on R1’s cognitive skills. 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. Exit interview was held with Administrator David Kim. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 15, 2025 · control 28-AS-20250506090808

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Administrator David Kim and explained the purpose for today’s visit. The facility is licensed to serve 1 Ambulatory Resident and 12 Non-Ambulatory Residents ages 60 and over (of which 6 may be bedridden). Facility has a hospice waiver for 6, there are currently 4 residents using hospice services. The Facility is a single story building located in Downey, CA. A tour of the facility included: 11 resident bedrooms, 7 bathrooms, living room, dining room, tv room, kitchen, laundry room, two (2) shaded patio areas, detached garage and tool sheds used for storage and emergency food supply. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility maintains the required Infection Control Plan. Operational Requirements: The facility has an approved fire clearance and maintain the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably available. The resident rooms have signal systems that were tested an operating properly. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. The fire extinguishers were observed throughout the facility and are fully charged. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested throughout the facility and measured within the required range of 105-120 degrees. There is a shaded patio/garden areas for residents. Staffing: There appears to be sufficient staffing at all times in the facility. With night staff that is trained and able to assist in care and supervision of the residents in the case of an emergency.(Continued on LIC809-C) Personnel Records-Training: Staff have criminal record clearance, current First-Aid training along with training in postural supports, Alzheimer’s and Dementia, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed 5 staff files with no issues observed, 2 staff were missing their first-aid training (prior to end of visit both staff were able to show completion of training done on 2/18/25) citation issued as both staff had expired first-aid certificates from 9/2024 and 12/2024 (details found on LIC800-D). Administrator David Kim certificate expires on 6/21/2025. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 5 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted on each floor/section: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities with a monthly calendar. There is sufficient space both indoor and outdoor for activities. 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: Medication is properly labeled and are centrally stored 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 Needs: Facility admits residents with dementia and staff files reviewed today all have required training documented. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit will be cited on the 809D. Exit interview held, a copy of the report and appeal rights were provided to Administrator David Kim.the state’s words, verbatim · CDSS document, Feb 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sanjay Vaid conducted an unannounced Required- 1 year visit. LPA met with Administrator David Kim and explained the purpose of the visit. There are 10 residents ages 60 and above [7 ambulatory, 3 non-ambulatory, & 3 bedridden]. A Dementia waiver and an approved hospice waiver for 6 residents is in place. Facility is a single-story home consisting of 11 resident bedrooms, 7 bathrooms, living room, dining room, tv room kitchen, indoor patio, laundry room, two (2) shaded patio areas, and detached garage. Administrator certificate expires 3/9/2024. The following were observed/inspected: • Five (5) resident files were reviewed [Physician's Report, admission agreement, ID/emergency information, negative test result for tuberculosis, Appraisal/Needs and Services Plan]. • Smoke detectors and carbon monoxide detectors were tested and are operable. Four fire extinguishers are fully charged. Last fire drill was conducted on 01/03/2024. • Sufficient supply of extra linen, towels and personal hygiene supplies are available. • Resident rooms had the required furniture and a comfortable temperature was maintained for residents. • Hot water temperature readings were within 105-120 Degrees Fahrenheit. • Auditory alarms were operable on exit doors. • Centrally stored medication records were observed. Medications were reviewed at 12:30 PM. • Four (4) staff files were reviewed. Staff have criminal record clearance, TB clearance, & staff training. • Staff responsible for direct care and supervision have valid First Aid/ CPR certificates. • Bathrooms are clean and fully operational with hand rails and non skid mats and shower chairs • Refrigerator appears sanitary with required temperature maintained. • Sufficient supply of perishable for 2 days & non-perishable foods for 7 days. • Cleaning agents are inaccessible to residents under the locked kitchen sink. • First Aid kit and Manual were inspected. • Side and rear yard areas had is clear from debris, no obstructions observed. Exit interview was conducted. A copy of this report was provided to Administrator David Kim.the state’s words, verbatim · CDSS document, Mar 6, 2024