Valley Villa Senior Living

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a Case Management Annual Continuation Inspection. At 10:10 a.m. LPA Urena arrived at the facility and rang the doorbell several times, however, there was no response. The LPA called the Administrator, Armenui Simityan and informed them the reason for the visit. The Administrator stated that they do not have any staff or residents at the current time, and that it would take her about 30 minutes to get to the facility. The LPA stated that they would wait for Administrator to arrive. At 11:15 a.m., the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. COMMON AREAS: The LPA observed common areas to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be purchased 01/14/2026. The fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. Facility telephone was observed during the time of the visit. Medications and first aid kits are located in a locked storage cabinet located in the hallway leading to bedrooms #4 and #3. KITCHEN: Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Laundry units are located next to the kitchen. Cleaning solutions and chemical items were inaccessible and locked away inside cabinets in the laundry area. Continues on LIC 809C... BEDROOMS: The facility is a single-story residential home with six (6) bedrooms, five (5) for resident use and one (1) for staff use and three (3) bathrooms. The bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats, sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote hand washing. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the restroom cabinets. OUTDOOR SPACE: The back patio has a covered outdoor area for resident use. There are gates on each side of the house designated for an emergency exits. Passageways were free and clear from obstruction. There are no bodies of water on the premises. The garage is attached to the house and remains inaccessible to residents. RECORDS: Residents’ records and Personnel records were not reviewed at this time due to facility not having any residents or staff at the time of the inspection visit. MEDICATIONS: Medications were not audited at this time due to facility not having any residents residing at the time of the inspection visit. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. At 10:35 a.m. LPA Urena arrived at the facility and rang the doorbell several times, however, there was no response. The LPA picked through the window and the facility was dark inside and appeared to be vacant. At 10:37 a.m., the LPA called the Administrator, Armenui Simityan and informed them the reason for the visit. The Administrator stated that they do not have any staff or residents at the current time. The Administrator stated that they were about two hours away from the facility and on their way out of town and would be back by January 2nd 2026, and there was no one available to open the facility for the inspection. The LPA informed the Administrator that they would come another day to complete the annual inspection.the state’s words, verbatim · CDSS document, Dec 30, 2025

Allegation investigated: Staff leaves resident in bed for an extended period of time. Staff does not attend to resident in a timely manner. Staff does not provide adequate meal service to resident. Staff does not administer medications as needed.

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced investigation visit at the facility regarding the allegations listed above. LPA arrived at the facility and the facility vacant at this time. The facility is going through renovations. No residents were at the facility on the day of the visit. One resident was relocated previous to the start of the renovation. The LPA communicated with the Administrator via the phone and read the report. The Administrator agreed to sign the report and return it to the LPA via email. On 08/27/2024, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced 10-day complaint investigation visit at the facility regarding the allegations listed above. LPA Urena spoke with staff and informed of the visit. The staff contacted the Administrator Armenui Simityan at 11:15 a.m. to inform them of the visit. The LPA spoke with the Administrator on the phone and explained the reason for the visit. LPA Urena conducted staff and residents' interviews from 11:19 a.m. to 1:22 p.m. The LPA reviewed records pertinent to the investigation from 1:25 p.m to 1:40 p.m. . Continues on LIC 9099C... Unsubstantiated Staff leaves resident in bed for an extended period of time. On the allegation that staff leaves resident in bed for extended periods of time, it is the concern of the reporting party (RP) that the staff do not assist residents to get up from the bed. Residents are kept in bed all the time except when residents receive physical therapy (PT) twice a week. To investigate the allegation, the LPA interviewed residents, and the interviews revealed that the facility has only one staff; consequently, the staff does not assist residents in getting up from bed. The LPA interviewed the staff (S1), and the staff stated that they can only assist residents with repositioning and transferring from bed to wheelchair, residents receive PT twice a week and assist residents with mobility. Record review revealed that residents in care are receiving PT twice a week for mobility. Based on the interviews and record review, although the allegation may have happened or is valid, based on the interviews, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Staff does not attend to resident in a timely manner. On the allegation that staff do not attend to residents in a timely manner, the concern of the RP that the facility staff do not attend to the residents when they call for help, and when the residents ask for something, the staff take a long time or ignores the request. The residents’ interviews revealed that one resident stated that when they ask for a condiment for food the staff often ignore their call and requests, or takes a long time (45 minutes to provide the condiment). The staff’s interview revealed that they do attend to the requests of the residents and denied ignoring the residents’ calls for help. Based on the information obtained through interviews, although the allegation may have happened or is valid, based on the interviews, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Continues on LIC 9099 C... page 3. Pg. 3. Staff does not provide adequate meal service to resident. On the allegation that staff does not provide adequate meal service, it is the concern of the RP that the staff only serves the same meals over and over, sometimes sandwiches for dinner or a bagel and sometimes macaroni. Residents’ interviews revealed that if they fall asleep during one of the three meals the staff won’t wake them up, and alleged that they did not get to eat because they fell asleep. One resident stated that the meals are ‘ok’. The staff only provides three meals, cold cereal in the mornings, and no snacks unless the residents ask for a snack. LPA Urena conducted a physical plant tour of the kitchen, and the facility appeared to have sufficient and a variety of foods for the residents in care. The staff’s interview revealed that they prepare three meals a day for the residents in care, which include vegetables, meat and fruit. Breakfast includes oatmeal, cereal, and drink. Staff stated that they provide snacks, but only if the residents request a snack. The snack typically consists of cookies. Although the allegation may have happened or is valid, based on the interviews, and observation, the staff provided at least three meals during the day, and a snack when requested by residents in care. Therefore, the allegation is deemed Unsubstantiated at this time. Staff does not administer medications as needed. On the allegation that staff does not administer medications as needed, it is the concern of the RP that the OTC pain medication is sometimes not given when asked for. To investigate the allegation the LPA conducted medication audit, and interviewed residents in care. The medication was properly documented in the Centrally Stored Medication and Destruction Record form (LIC622). The residents interview revealed that sometimes they will ask for the over-the-counter pain medication and the staff will not provide as requested. One resident stated that they get their prescribed medications on time. Although the allegation may have happened or is valid, based on the interviews, and observation, the staff provided prescribed medications as prescribed by the physician. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview was conducted. Copies of the report were issued. Staff does not ensure resident's grooming needs are met. On the allegation that staff does not ensure resident’s grooming needs are met, it is the allegation of the RP that they had observed residents’ hair being hair knotted and tangled from not being brushed, and residents’ diapers are not being changed frequently enough. Residents’ interviews revealed that they get a diaper change only twice a day, and not at night. They must sleep on their wet/soiled diaper throughout the night. The staff’s interview revealed that they change diapers twice a day and when the residents request at night. Based on the information obtained through interviews, the staff is not following regulations based on the staff’s answer on how many times the staff attend to the residents’ needs for a change in diaper. Therefore, the allegation is deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 9099-D). Citations were issued. Exit interview was conducted. A copy of the report and Appeal rights were issued.the state’s words, verbatim · CDSS document, Apr 22, 2025 · control 29-AS-20240821134235

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87625(b)(2) · Plan of correction due date: Apr 22, 2025

87625(b)(2) Managed Incontinence. …The licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as R1 and R2 were not check periodically and at night, which poses an immediate health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Apr 22, 2025

Plan of correction: The Administrator agreed to do the following: 1. Ensure that the new staff will follow regulations and will check and change the residents needs every two hours. The Administrator stated that the facility will be hiring all new staff, and will be trained according to the regulations.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. At 10:05 a.m. LPA Urena arrived at the facility and rang the doorbell several times and waited for a staff to answer the door; however, there was no response. At 10:37 a.m., the LPA called the Administrator, Armenui Simityan and informed them the reason for the visit, and asked about the facility staff not responding to the doorbell. The Administrator stated that they do not have any staff or residents at the current time. Facility had two residents living at the facility about two and a half months ago. One of the two residents, went back home, and the second resident relocated to a facility to be closer to their primary physician, consequently the facility is empty at the time of today’s annual inspection visit. Furthermore, the Administrator stated that they took the opportunity to do some cosmetic remodeling, such as painting inside and out, and adding new furniture to the facility. Administrator stated that they were not sure if they needed to inform the Community Care Licensing Department (CCLD) of the remodeling to the facility. LPA Urena reminded the Administrator that any changes, upgrades, or construction should be notified to the Regional Office (RO), via email, prior to starting any work that may affect the residents in care. The LPA informed the Administrator that they needed to conduct the annual inspection. The Administrator stated that they were about an hour away from the facility. The LPA stated that they would wait for the Administrator to arrive. At 12:15 p.m., the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. COMMON AREAS: The LPA observed common areas to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 08/25/2024. The fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. Facility telephone was observed during the time of the visit. Medications and first aid kits are located in a locked storage closet in the office area. Continues on LIC 809C... KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Laundry units are located next to the kitchen. Cleaning solutions and chemical items were inaccessible and locked away inside cabinets in the laundry area. BEDROOMS: The facility is a single-story residential home with six (6) bedrooms, five (5) for resident use and one (1) for staff use and three (3) bathrooms. The bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats, sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the restroom cabinets. OUTDOOR SPACE: The back patio has a covered outdoor area for resident use. There are gates on each side of the house designated for an emergency exits. Passageways were free and clear from obstruction. There are no bodies of water on the premises. The garage is attached to the house and remains inaccessible to residents. RECORDS: Residents’ records and Personnel records were not reviewed at this time due to facility not having any residents or staff at the time of the inspection visit. MEDICATIONS: Medications were not audited at this time due to facility not having any residents residing at the time of the inspection visit. LPA Informed the Administrator that they need to inform the LPA when the remodeling is completed, and before accepting new residents. LPA will return to the facility to conduct a case management visit to ensure that all remodeling meets the departments criteria and regulations. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:35 a.m., the LPA met with staff and explained the reason for the visit. At 10:37 a.m., the Administrator, Armenui Simityan arrived at the facility. At 11:05 a.m., the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. OUTDOOR SPACE: At 11:10 a.m., the LPA observed the back patio which has a covered outdoor area for resident use. There are gates on each side of the house designated for an emergency exits. Passageways were free and clear from obstruction. There are no bodies of water on the premises. The garage is attached to the house and remains inaccessible to residents. BEDROOMS: The facility is a single-story residential home with six (6) bedrooms, five (5) for resident use and one (1) for staff use and three (3) bathrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Starting 11:25 a.m., hot water measured between 105.1 and 107.2-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the restroom cabinets. Continued on LIC-809-C. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:35 a.m., hot water measured at 106.6-degree Fahrenheit. Laundry units are located next to the kitchen. Cleaning solutions and chemical items were inaccessible and locked away inside cabinets in the laundry area. COMMON AREAS: The LPA observed common areas to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 09/27/2023. At 11:32 a.m., fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. Facility telephone was observed during the time of the visit. Medications and first aid kits are located in a locked storage closet near the activity room. Starting at 10:08 a.m., the LPA conducted interviews with two (2) out of four (4) residents and one (1) staff. During the time of the visit, the LPA requested the following documents: Emergency Disaster Plan, Infection Control Plan, LIC 9020A, LIC 308, and LIC 500. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 25, 2024