Valley Royale Home Care

Type of visit: POC

Licensing Program Analyst, LPA Noel Wolf Petersen arrived to conduct a case management related to a recent complaint, where it was learned that a employee of the facility was not associated to the facility on guardian, and it was asked as part of a Plan of Correction that a plan would be made for the fate of the employee. LPA met with the administrator genario Baisac and explained the purpose of the visit. The LPA arrived to observe the facility for the presence of S1, during one of her previously known shifts. S1 is not currently present in the facility. interviewed 2 staff, 1 administrator, 1 client. Consensus statement was made that S1 has not worked in the facility in the time that the LPA was not here. LPA gave guidance that S1 has fingerprints and a social security number on file and could therefore return to the facility when a transfer of the fingerprints is complete before those fingerprints expire. The Administrator provided that the staff was or was not planning to return to the facility for now, but she is welcome back. she has a complication with a exclusivity clause at one of her employments. The facility is compliant with the POC, and a Letter of POC clearance was issued. no citations were issued as part of this visit. a copy of the report was read and given to the administrator. exit interview was conducted.the state’s words, verbatim · CDSS document, May 1, 2026

Allegation investigated: False Claims

Licensing Program Analyst, LPA, Noel Wolf Petersen, arrived to the facility to conduct a complaint investigation, 8am, 4/17/26. LPA met with Genaro Basiac to explain the purpose of the visit The allegation of false claims was clarified to be a staff falsely represented as another person, through administrator interview and a review the staff records for the employes and LIC500, it was learned that staff records were not complete for 4 staff, and in one instance the a employee was not added to the staff roster to obfuscate that her fingerprinting status was not complete. Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, are being cited on the attached LIC 9099D. A copy of the report was read and given to the administrator with the appeal rights, an exit interview was conducted. Substantiatedthe state’s words, verbatim · CDSS document, Apr 17, 2026 · control 27-AS-20260401105300

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80065(i)(5) · Plan of correction due date: Apr 18, 2026

80065 Personnel Requirements (i) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations This requirement was not met as evidenced by: administrator interview where it was described that an employee does not have thier fingerprinting done, the LPA observed this employee in the facility on 2 seperate visits. Not following this requirement poses an immediate risk to the clients health, saftey, and personal rightsthe state’s words, verbatim · CDSS document, Apr 17, 2026

Plan of correction: LPA is asking a staff should be asked to leave, not permitted to work a shift until the finger printing is completed. Licensee should send either confirmation of the fingerprinting completion or confirmation of dismissal of the employee. The fingerprinting process might take a few days, Licensee should provide an update weekly until its done.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(3) · Plan of correction due date: Apr 24, 2026

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (3) Ability to maintain or supervise the maintenance of financial and other records. This requirement was not met as evidenced by: in a record review of 4 of 4 staff records reviewed have employees with no method of identity verification (social sequrity number). Not following this requirement posed a potential risk to the clients health, saftey, and personal rightsthe state’s words, verbatim · CDSS document, Apr 17, 2026

Plan of correction: Licensing is asking for an form of identiity verification for each employee, including but not limited to a photocopy of a drivers license picture ID with name and age, or a Passport photo with name and age or a social security number

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA Noel Wolf Petersen, arrived unannounced to the facility to conduct an annual inspection 7:15am on 3/27/26, LPA met with administrator Genaro Baisac Jr by phone to explain the purpuse of the visit. Valley Royale Home Care is a RCFE with a current census of 3, and a total capacity of 6. 2 nonambulatory (residents makes use of a wheelchair), 1 ambulatory (makes use of a walker) . 1 resident is on hospice, there is no home health contract but hospice plan outlines nursing visits twice a week. Physical inspection included but was not limited to the kitchen, bathrooms, bedrooms, common areas, storage areas, exteriors and evacuation route gate. there is some construction going on related to replacing a vynl laminate floor in a front common area and it is in a state of disrepair. The exterior has some trash related to the construction, its traffic areas leading to the emergency exit gate unramped, a tripping hazard in the form of a unwound hose, and laundry detergent stored unlocked. LPA gave guidance to clean up the trash, move the temporary ramp to be useable, and move the hazards. The construction was described to the LPA as not modifying the subfloor, and being completed in a short order(sunday). Kitchen has adequate storage for food for 2 days perishable and 7 days nonperishable, the kitchen has lockable storage for the medication, and sharps. Toxics(except laundry detergent) are locked outside. Resident Bedrooms are furnished and have adequate space for the resident belongings and required furniture. Bathrooms have functional hardware, water temperature is measured at 105-120*F. Exterior has a pool, which is locked while not in use. Evacuation route gate swings freely and latches closed. Continued on C page. 3 client files were reviewed, one has no needs and services plan, client prn documentation is an indication of yes/no dispersal, there are is 15+ day gap in the MAR administration record for Jan-Feb 2026(a mediction)) for a resident, Missing exceptions for 4 restricted conditions (oxygen administration, incontinence care, catheter, support with all ADL's). LPA gave guidance to make new 602 appointments for any clients who have changed in some aspect of thier health, then make updated needs and services plans based on those updated 602's. LPA gave guidance for the Licensee to either send granted exception letters from the department for the 4 restricted conditions, or send a Email to the LPA formally requesting exception review for those four restricted conditions. 2 clients interviewed, last client was not responsive with the interview. 5 staff Files were reviewed, two staff have expired first aid back taken back in 2019, remaining 3 do not have first aid training. Last dementia training in the staff binder is documented in 2019. Staff interviewed do not remember taking required continuing training for many years, for regular topics, dementia topics, or the restricted condition topics. Medication is being prepoured and prepared outside the presence of the resident. LPA gave guidance to not store medication outside its orginal container, and to make a plan to get the staff trained in the yearly required topics. 3 staff interviewed. Administrator files were not reviewed, Missing the facility sketch with evacuation route, personal rights poster, and employee rights poster. LPA is asking for a copy of the workers comp and liability insurance, the LIC 610e, to be sent by email to(noel.wolfpetersen@dss.ca.gov). Fire extinguishers are dated 13 March 2026, first aid kit has all the required items. Smoke/co alarm is functional. Citations, technical violations, and technical assistances were issued as part of this visit, LPA recommended to elect for participation of the licensee in the Technical Support Program with regard to required documentation, staff training, and administrator responsibilities. Appeal rights were provided. A copy of the report was read over the phone to the administrator and given to the staff physically. exit interview conducted.the state’s words, verbatim · CDSS document, Mar 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct one year annual/required visit. LPA Lund met with Administrator Genaro Baisac and explained the reason for the visit. Census: 3 LPA Lund and Administrator Genaro Baisac tour/inspected the facility. LPA inspected the dining area, living area, and all other areas for resident use. LPA observed to be furnished and maintained in compliance at this time. The Facility had a Medication cabinet (locked) and reviewed and in compliance. First aid kit was observed in the medication cabinet to be present and contained all required components at this time. A tour of the (3) resident bedrooms, was conducted all three rooms will be shared. Furnishings intended for use by the residents were observed to meet the needs of the residents at this time. The facility also had one bathroom for the residents. The facility has two rooms for staff use. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. The facility has a swimming pool which is locked. The facility has two fire extinguishers that and carbon monoxide are in compliance. The has a working telephone. LPA Lund reviewed two staff & two residents files are in compliance. No deficiencies were cited at this time and copy of report given.the state’s words, verbatim · CDSS document, Mar 24, 2025

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct annual/required visit. LPA Lund met with Administrator Genaro Baisac and explained the reason for the visit. Census: 2 LPA Lund and Administrator Genaro Baisac tour/inspected the facility. LPA inspected the dining area, living area, and all other areas for resident use. LPA observed to be furnished and maintained in compliance at this time. The Facility had a Medication cabinet (locked) were medication is stored. First aid kit was observed in the medication cabinet to be present and contained all required components at this time. A tour of the (3) resident bedrooms, was conducted all three rooms will be shared. Furnishings intended for use by the residents were observed to meet the needs of the residents at this time. The facility also had one bathroom for the residents. The facility has two rooms for staff use. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. The facility has a swimming pool which is locked. The facility has two fire extinguishers that and carbon monoxide are in compliance. The has a working telephone. LPA Lund reviewed two staff & two residents files are in compliance. No deficiencies were cited at this time and copy of report given.the state’s words, verbatim · CDSS document, Sep 27, 2024

Type of visit: Prelicensing

Announced prelicensing visit was made by LPA Lund. LPA Lund met with applicant, Genaro Baisac Jr. and explained the reason for the visit. Census: 0 The facility will be licensed to serve up to (6) residents at any given time. This Applicant is seeking a facility with six nonambulatory residents. LPA Lund and applicant Genaro Baisac Jr. tour/inspected the facility. LPA inspected the dining area, living area, and all other areas intended for resident use. LPA observed to be furnished and maintained in compliance at this time. The Facility had a Medication cabinet (locked) were medication will be stored. First aid kit was observed in the Medication cabinet to be present and contained all required components at this time. A tour of the (3) resident bedrooms, was conducted all three rooms will be shared. Furnishings intended for use by the residents were observed to meet the needs of the residents at this time. The facility also had one bathroom for the residents. The facility has two rooms for staff use. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. The facility has a swimming pool which is locked. The facility has two fire extinguishers that and carbon monoxide are in compliance. The has a working telephone. This facility has been found to be in compliance at this time. Genaro Baisac Jr. completed the Component 111 requirements and Mitigation Plan. Exit interview and report left.the state’s words, verbatim · CDSS document, Mar 21, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Genaro R Baisac Jr - Applicant//Administrator Interview Method: Telephone interview On March 1, 2024, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the 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, Mar 1, 2024