Valley Vista Residential Care III

Type of visit: Case Management - Other

At 8:00am, on 7/13/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct a Case Management - Other visit. LPA met with Licensee/Administrator Evelyn Strampe, announced who he was and the reason for the visit. LPA and Licensee conducted a tour of the facility, including the garage. Upon arriving to the facility LPA noted a couch and boxes placed in front of the exterior side of the emergency exit of bedroom #1, this is the designated bedridden room. The door could not be opened from the inside. The Licensee stated they placed the items there over the weekend while cleaning out the garage. The Licensee and staff cleared the items away from the door while LPA was here. While touring the garage at 8:16am LPA noted nine (9) firearms laying on a work bench not in a locked gun safe, that meets the regulatory standards established by the Department of Justice in Section 4100 of Title 11 of the California Code of Regulations. Licensee states they are unloaded and are a collection belonging to a family member. They also state there is no ammunition at the facility. During a visit conducted on 7/9/2026 LPA noted two uncleared individuals at the facility that were residing in the garage. During today's visit LPA did not observe the two individuals at the facility. Licensee states they have not returned to the facility since 7/9/2026. (Continued on LIC 809-C) During the visit conducted on 7/9/2026 Licensee stated Resident #1 (R1) went to the hospital on 6/28/2026. LPA asked if the Licensee had reported the incident to Community Care Licensing (CCL), the Licensee stated that had not at the time of that visit, and the LPA reminded the Licensee they needed to submit a report. As of today's visit record review of reports sent to CCL reveal no report has been submitted for R1's incident on 6/28/2026 and the Licensee states they have not had time to do so. Since then R1 went to the hospital an additional time on 7/7/2026 and passed on 7/12/2026. During the facility tour today LPA did not observe any unlocked medications. Exit interview conducted, deficiencies cited on LIC809-D pages, a civil penalty in the amount of $500 for firearm violation is being assessed on the attached LIC421IM, a civil penalty for a repeat violation within the last twelve months of the fire clearance in the amount of $1000 is being assessed on the attached LIC421IM, appeal rights and report provided to the Licensee.the state’s words, verbatim · CDSS document, Jul 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.282(c)(1) · Plan of correction due date: Jul 14, 2026

(c)...licensees’ firearms, ammunition, or both shall be centrally stored in the facility and in the following manner: (1) Firearms shall be centrally stored unloaded, in a locked gun safe, that meets the regulatory standards established by the Department of Justice... This requirement was not met as evidenced by: Based on observation and interview, the licensee did not lock up nine firearms per regulation which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 13, 2026

Plan of correction: Licensee states they will move the firearms today to their storage unit off facility premises. They will also conduct staff training on this regulation and write a statement of understanding. Documentation training and the statement will be emailed to the LPA on or before 7/20/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87202(a) · Plan of correction due date: Jul 14, 2026

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal... This requirement was not met as evidenced by: Based on observation and interview, the licensee blocked the emergency exit of the bedridden room by placing a couch and boxes infront of the exterior of the door which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 13, 2026

Plan of correction: Licensee moved the items to unblock the door during LPA visit. The Licensee states they will also conduct staff training on this regulation and write a statement of understanding. Documentation training and the statement will be emailed to the LPA on or before 7/20/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Jul 27, 2026

(a) Each licensee shall furnish to the licensing agency...(1) A written report shall be submitted to the licensing agency... within seven days of the occurrence... (D) Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by: Based on interview and record review, the licensee did not submit a report to CCL for an incident that occurred to R1 on 6/28/2026 which poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 13, 2026

Plan of correction: Licensee states they will submit all reports for R1 to LPA today.

Type of visit: Case Management - Other

At 3:45pm, on 7/9/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct a case management - other visit. LPA met with Licensee/Administrator Evelyn Strampe, announced who he was and the reason for the visit. Today, 7/9/2026, at 10:24am this LPA received a call from Witness #1 (W1) stating they visited the facility and noted medications in the refrigerator were not locked up. The Licensee went to put the medications in a refrigerator in the garage where W1 observed Person #1 (P1), in the garage of the facility and it appeared as though P1 was living in the garage. When W1 asked the Licensee who P1 was the Licensee stated P1 is a family member. At 10:46am LPA called the Licensee and the Licensee stated that they had left unlocked insulin pens in the refrigerator located inside the facility because there was not enough room in their locking box where they keep other medications in the refrigerator. When asked about P1 the Licensee stated that P1 is a family member and is not cleared. The Licensee also stated P1 has been living in the garage since 6/30/2026. When LPA arrived at the facility for today's visit LPA noted two people in the garage. P1 identified who they were and Person #2 (P2) stated they are also a family member of the Licensee. P1 and P2 stated they have both been living and sleeping in the garage and they are working to leave by this evening. Licensee states P1 and P2 have come inside the facility to use the bathroom. Record review revealed P1 and P2 have not been cleared to work or reside at the facility and the Licensee states they have not sent them for fingerprint clearance. (Continued on LIC809-C) LPA toured the facility with the Licensee and during the tour noted an unopen bottle with thirty (30) tablets of aripirazole 5mg belonging to a former resident and a bottle with one hundred twenty two (122) tablets of quetiapine fumarate 50mg belonging to a current resident, both in an un-lockable drawer of a dresser located behind the living room couch accessible to residents in care. Licensee stated they do not know how they got there. Licensee took the medications and locked them up with the other medications. Exit interview conducted, deficiencies cited on LIC809-D pages, two civil penalties for $100 per day for a maximum of 5 days in the amount of $500 each for criminal record clearance violation is being assessed on the attached LIC421BC, a civil penalty for a repeat violation within the last twelve months in the amount of $250 is being assessed on the attached LIC421FC, appeal rights and report provided to the Licensee.the state’s words, verbatim · CDSS document, Jul 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jul 10, 2026

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2)Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above when P1 and P2 were residing at the facility and not cleared, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 9, 2026

Plan of correction: Licensee states P1 and P2 will spend the night at a hotel tonight and furture nights until they have another place to stay. They also stated they will work to have P1 and P2 cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Jul 10, 2026

(h) ...(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above when they left medications unlocked in the kitchen refrigerator and dresser behind the couch in the living room accessible to resident which poses an immedicate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 9, 2026

Plan of correction: Licensee stated they ordered a larger lock box for refrigerated medications and will email the invoice to the LPA. They also stated they will create a log to track thorough checks of the facility have been conducted weekly for unlocked meds and hazardous items. They also state they will work to minumuize how much stuff they have in the facility so they can better track what they have. Licensee will submit the weekly check sheet to the LPA by 7/10/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Jul 23, 2026

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement was not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above when they allowed P1 and P2 to reside and sleep in the uncleared garage which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 9, 2026

Plan of correction: Licensee states no one will reside in the uncleared garage and they will submit a statement of understanding of this regulation to the LPA by 7/23/2026.

Type of visit: Case Management - Other

At 9:00am, on 5/13/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct a Case Management - Other visit. LPA met with Licensee/Administrator Evelyn Strampe, announced who he was and the reason for the visit. During today's visit LPA and Administrator toured the facility and LPA checked the well-being of the residents. While touring the facility LPA noted two bottles of Lysol aerosol spray left out, one in each restroom; an unmarked spray bottle in one bathroom with a liquid in it that staff stated is bleach; in the south side yard a full bottle of tire cleaner; two tubes of hydrocortisone cream 1% and the licensee's personal supplement's in a resident bedroom. All of these items were unattended and accessible to residents in care. LPA reviewed resident files and medication orders. LPA noted that Resident #1 (R1) has physician order's dated 4/20/2026. The orders include Aspirin 81mg one tablet twice daily, metformin 500mg one tablet by mouth twice daily, and megestrol 800mg/20mL take 20ML by mouth daily; the facility does not have these medications, the licensee states they were discontinued, and they do not have discontinuation orders. The orders also state metformin 5mg take one tablet twice daily and the facility is giving 10mg tablets twice daily. The physician orders for R1 dated 4/20/2026 state insulin at a sliding scale and the licensee stated they are not following these orders, they are following orders provided by R1's responsible party. Licensee states R1's responsible party is not a physician. Exit interview conducted, deficiencies cited on LIC809-D page, civil penalties in the amount of $250 for a repeat violation are being assessed on the LIC421FCs, report signed, report and appeal rights provided to the Licensee.the state’s words, verbatim · CDSS document, May 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: May 14, 2026

Storage Space and Access (a) ...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances,...and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: Based on observation and record review, the licensee did not ensure poisonous substances and cleaning solutions were inaccessible to residents which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 13, 2026

Plan of correction: Licensee locked up the items as they were discovered and states they will provide LPA a statement of understanding of how this violation could affect residents and a plan to prevent in the future. They will email this to the LPA on or before 5/20/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(4) · Plan of correction due date: May 14, 2026

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall...provide for assistance in obtaining such care, by compliance with the following:(4)The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interview and record review, the licensee is not assisting with medication administration per R1's physician orders which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 13, 2026

Plan of correction: Licensee states they will obtain accurate orders for R1 from R1's primary care physican and ensure they have the correct medications by 5/14/2026 and email the orders and photo of medications to LPA on 5/14/2026.

Type of visit: Case Management - Other

At 2:05pm, on 4/14/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct a Case Management - Other visit. LPA met with Licensee/Administrator Evelyn Strampe, announced who he was and the reason for the visit. During today's visit LPA and Administrator toured the facility and LPA checked the well-being of the residents. LPA attempted to review the facilities centrally stored medication and the licensee could not provide the Centrally Stored Medication and Destruction Records (CSMDRs) for the five residents the facility manages medications for. This was previously cited during a visit by the LPA on 1/21/2026, the facility submitted the plan of correction on 1/29/2026, during the LPAs visit conducted on 2/10/2026 Licensee and LPA reviewed completed CSMDRs, but as of today's visit the Licensee states they have not continued to follow their protocol, does not have CSMDRs completed for medications received since the LPAs last visit and is not able to find the previously completed CSMDRs. LPA also reviewed the resident records noting three of six residents have an appraisal conducted within the last year. LPA offered Technical Support Services to the Licensee. Exit interview conducted, deficiencies cited on LIC809-D pages, a civil penalty in the amount of $250 for a repeat violation is being assessed on the LIC421FC, report signed, report and appeal rights provided to the Licensee.the state’s words, verbatim · CDSS document, Apr 14, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(1) · Plan of correction due date: Apr 21, 2026

(h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances:... This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above when they could not provide the CSMDRs for the five of the six residents they store and assist administering medications to which poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Licensee will submit completed CSMDRs for all five residents the facility manages medications for to the LPA on or before 4/21/2026 and updated CSMDRs will be submitted to the LPA on 6/1/2026 and 7/1/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a) · Plan of correction due date: Apr 21, 2026

(a) The pre-admission appraisal... shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition... This requirement is not met as evidenced by: Based on record, the licensee did not comply with the section cited above when three of six residents did not have a current appraisals which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2026

Plan of correction: Licensee will create a reappraisal for each resident and submit to the LPA on or before 4/21/2026

Type of visit: POC

At 1:40pm, on February 10th, 2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct a Plan of Correction (POC) visit. LPA met with Licensee/Administrator Evelyn Strampe, announced who he was and the reason for the visit. During today's visit LPA and the Licensee conducted a tour of the physical plant of the facility, LPA noted the backyard and sideyards have been cleared of debris and medical equipment. There are no obstructions to walkways or exits. LPA also checked the wellness of all five residents in care. Administrator and LPA conducted a review of the centrally stored medications. LPA reviewed the implementation of multiple POCs the Licensee is working on, to correct recently cited deficiencies, LPA noted progress was made on the POCs. LPA offered the Licensee support through the Department's Technical Support Program (TSP). LPA and Licensee reviewed regulations requiring enough staff to meet the residents needs during the day and at night. Licensee has a plan in place to complete the remaining POCs. During this visit no deficiencies were cited, but the LPA may return at a later date if citations are warranted. Exit interview conducted, report signed, and report provided to Licensee Evelyn Strampe.the state’s words, verbatim · CDSS document, Feb 10, 2026

Allegation investigated: Facility staff did not ensure centrally stored medicines were locked

On 1/13/2026, at 1:08pm Licensing Program Analyst (LPA) Haner-Tomasko conducted a complaint visit to the facility to investigate the allegation to this complaint. LPA met with Licensee/Administrator Evelyn Strampe and explained the purpose of the visit. During the visit the LPA toured the facility, reviewed resident records, and conducted interviews. On the allegation: Facility staff did not ensure centrally stored medicines were locked. It was alleged that resident medications, gabapentin and seroquel, were in resident bedrooms in unlocked locations. LPA interviews revealed the seroquel was located in an unlocked bedside table of Resident #1’s (R1’s) bedroom and the gabapentin was in an unlocked closet of Resident #2’s (R2’s) bedroom. (Continued on LIC9099-C) Substantiated Both medications were unattended at times and accessible to residents in care. LPA noted during resident record review that 5 of 6 residents currently residing in the facility cannot manage their own medications. During today’s visit LPA observed and photographed the following medications unattended and unlocked: at 1:10pm in Resident #4's (R4's) bedroom a bottle of Bayer aspirin with additional unmarked capsules inside with the aspirin tablets and a bottle of glucosamine chondroitin with capsules of different colors; at 1:16pm in Resident #1 (R1) and Resident #3's (R3's) bedroom a container of the Licensee's personal belongings including four medicated tubes of hydrocortisone cream, bottle of B-12 vitamins, bottle of alpranax, and in a separate bag in the dresser 9 medication bottles with medication in them including 2 bottles of hydromorphone 4mg, one bottle with 182 tablets and the other with 30; at 1:20pm in Resident #2's (R2's) bedroom a bottle of iron tablets, two bubble packs of medications, and two bottles of medications. On 12/31/2025 LPA conducted an annual facility visit and cited for cleaning solutions and medications left unlocked and unattended and on 2/7/2025 during a complaint visit the facility was cited for centrally stored medications not being locked. Licensee stated they did not do a thorough check after the annual visit on 12/31/2025 because they were busy with the residents and had to to take care of other things for the facility. They also said they do not have enough room to store all the medications in the medication drawers located in the kitchen. LPA ensured Licensee locked up all medications in other locked storage during today's visit. Since this is a repeat violation of the same Title 22 regulation within 12-months an immediate civil penalty in the amount of $250 is being assessed today, for every day this deficiency is not corrected an additional civil penalty can be assessed of $100/day. Based on all interviews conducted, record review and LPA observation, at this time the above allegation was found to be substantiated, there is a preponderance of the evidence to prove that the alleged violation occurred. Exit interview, deficiencies cited on LIC9099-D page, an immediate civil penalty in the amount of $250 is being assessed today on the attached LIC 421FC, report signed, report and appeal rights provided to the Licensee.the state’s words, verbatim · CDSS document, Jan 13, 2026 · control 29-AS-20260112082818

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jan 14, 2026

(h) ...(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by; Based on observation and interviews, the licensee did not comply with the section cited above when staff left multiple medications throughout the facility accessible and unlocked which possessed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 13, 2026

Plan of correction: Licensee locked up all medications found during the tour during LPA's visit. Licensee will create a policy to ensure medications are locked, include faciity checks for unlocked medicines and the destruction of discountued medications and email the policy to the LPA on or before 1/20/2026.

Type of visit: POC

On 1/13/2026, at 1:15pm Licensing Program Analyst (LPA) Haner-Tomasko conducted a Plan of Correction visit to the facility above. LPA met with Licensee/Administrator Evelyn Strampe and explained the purpose of the visit. On 12/31/2025, the facility was cited for a violation of the facilities approved fire clearance for retaining Resident #2 (R2) who is bedridden without a bedridden clearance. Upon today’s visit LPA observed R2 continues to reside in the facility without bedridden clearance posing a potential health and safety risk to R2. Civil Penalties will be issued for period 1/1/2026 – 1/13/2026, which is a total of thirteen days, at $100.00 per day. Civil Penalties will accrue as long as R2 is retained at the facility while considered bedridden and the facility does not have an approved fire clearance to retain a bedridden resident. Exit interview conducted, daily civil penalties have been assessed on the original visit, the LIC421FC, copy of report and appeal rights provided to the Licensee.the state’s words, verbatim · CDSS document, Jan 13, 2026

Type of visit: Office

On 01/07/2026, an Informal Conference was held at the Goleta Office. In attendance included Licensing Program Manager (LPM) Kelly Burley, Licensing Program Analyst (LPA) Garrett Haner-Tomasko, and Licensee Evelyn Strampe. The purpose of this Informal Conference is to discuss non-compliance of both facilities the licensee has, Valley Vista Residential Care (405801800) and Valley Vista Residential Care III (405850047). The Administrative Action process was explained to the licensee, as well as the role of an informal conference. The licensee entity has been suspended by the Secretary of State due to taxes not filed and taxes owed. The Regional Office (RO) has been consistently following up with the licensee in an effort for the licensee to correct the status. The licensee has made slow progress, and the need for a more proactive and faster approach was discussed. Other items discussed included citations previously issued for fire clearance violations for bedridden residents; incomplete centrally stored medication and destruction records; reappraisals not completed and inadequate resident records; inadequate emergency disaster plan and drills; seatbelt and gait belt restraints; dangerous items accessible, including medications; restricted and prohibited health conditions; expired food; staff using a resident’s private restroom. An incident from 04/23/2025 was also discussed, where no staff were present at Valley Vista Residential Care III with residents unattended, while the licensee went to the store. A general lack of staffing was also discussed, based on this incident and other comments the licensee has made. The licensee was reminded of their responsibility to provide sufficient staffing to meet the needs of all residents, as well as sufficient time dedicated to their role as an Administrator to ensure the facility is in compliance. (Continued on LIC809-C) Licensee Evelyn Strampe was informed this Informal Conference is a part of the Administrative Action process and that further non-compliance may result in a referral to the Department’s Legal Division for Administrative Action. The licensee was informed the RO may make additional unannounced visits to both facilities to check on compliance, and the visits may occur on any day or at any time. Exit interview conducted and copy of today's report was provided to the licensee.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Required - 1 Year

At 9:45am, on 12/31/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee Evelyn Strampe, announced who he was and the reason for the visit. Licensee and LPA conducted a full tour of the facility. This facility is a single story residential home with five resident bedrooms (one is dual occupancy), two full bathrooms. There is a living room with dining space and a kitchen. There is access to the laundry area off the kitchen as it also gives access to an emergency exit and one of the full bathrooms. At 9:57am in the laundry area LPA observed an open package of laundry detergent pods, two aerosol cans of Lysol disinfectant and bottles of rubbing alcohol not locked up accessible to residents; at 10:05am in the kitchen LPA observed medications not secure in the refrigerator and a sharps container with used syringes with needles not secure sticking plunger side up out the top of the sharps container accessible to residents in care; at 10:11am in a dresser behind the living room couch LPA observed approximately 9 bottles of the Licensees personal medications not locked up accessible to residents in care; and at 10:26am in the backyard on the south side of the facility a half bottle of Clorox stain remover and half bottle of hair & grease drain opener also accessible to residents in care. LPA observed boxes and clothing blocking the emergency exit off the laundry area and a night stand blocking the emergency exit off the bedroom to the left of the front door of the facility. LPA noted that the backyard and the front yard both have seating and shade for residents and visitors. LPA noted fresh fruit in the kitchen for residents to enjoy. LPA tested facility hot water at 109*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. (Continued on LIC809-C) LPA conducted a resident record review finding four of the six residents are at risk if given direct access to hazardous items (disinfectants, poisons, etc.) and LPA observed three of those four residents walk independently in the facility during the visit. During resident record review Licensee admitted they use a gait belt to keep Resident #1 (R1) in a recliner in the living room to prevent the resident from wandering or getting up to go out a door. LPA reviewed with the Licensee that this is a restraint and cannot be used for this purpose. LPA cited a deficiency and the Licensee stated they will not restrain the resident further. Resident record review also revealed Resident #2 (R2) is considered bedridden and this facility does not have a fire clearance for a bedridden room. Licensee stated to LPA they have not seen R2 turn or reposition in bed independently recently as they provide R2 all mobility assistance and R2 likely cannot follow instruction to do so independently. LPA and Licensee conducted a partial review of the annual care tool modules. LPA will have to return to finish the annual visit at a later date. Exit interview conducted, deficiencies cited on LIC809-D pages, report signed, report and appeal rights provided to the Licensee.the state’s words, verbatim · CDSS document, Dec 31, 2025

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Staff left residents unattended

On 05/06/2025 at 08:40am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to investigate the allegation to this complaint. LPA met with Licensee - Evelyn Strampe and explained the purpose of the visit. During the visit, LPA toured the facility, checked the well-being of the residents, interviewed the Licensee, a resident, and obtained relevant documents. On the allegation: Staff left residents unattended. It was alleged, on 4/23/2025 there were no staff on the facility premises for a period of time between 1:00 pm and 2:00 pm. During LPA interview with the Licensee, the Licensee stated they left the facility unattended for 15-20 minutes to get fresh produce at the store close by. The Licensee stated no other staff were on the premisis and they left two residents unattended for that time period. Based on the information obtained, the allegation is deemed Substantiated at this time. Exit interview,the state’s words, verbatim · CDSS document, May 6, 2025 · control 29-AS-20250427204627

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: May 7, 2025

Personnel Requirements. (a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on interview, the Licensee did not comply with the section cited above when they left the facility to go shopping leaving residents unattended, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 6, 2025

Plan of correction: Licensee agrees to provide LPA with a signed letter of understanding of Title 22, Division 6, Chapter 8, Article 7, Regulation 87411(a) and a written plan with measures to ensure staff are on the premises at all times by 05/07/2025.

Allegation investigated: Facility staff did not ensure centrally stored medicines were locked

Licensing Program Analyst's (LPA's) Haner-Tomasko and De Leon conducted a 10-day Complaint visit to the facility above. LPA met with Evelyn Strampe Administrator and explained the purpose of the visit. LPAs toured facility kitchen and locked garage, conducted interview with Administrator. When touring the kitchen LPAs observed the medication drawer and the refrigerator and toured the locked garage and observed the refrigerator and medication. On the allegation: Facility staff did not ensure centrally stored medicines were locked. LPA De Leon toured facility kitchen and observed unlocked medication drawer. Did not observe any medications in the refrigerator and observed food properly stored. LPAs toured the locked garage and observed medications stored in the refrigerator in the garage. Based on administrator interview the LTCO visited the facility a few days prior to this visit and observed unlocked liquid lorazepam in the kitchen refrigerator and the administrator admitted that this was the case at the time of the LTCO's visit. (Continued 9099-C) Substantiated Based on the evidence this allegation is deemed Substantiated at this time. Exit interview conducted, deficiency cited, copy of report, and appeal rights printed for Administrator. in containers which protect the safety, acceptability and nutritive values of the food, and free of damage. Based on the evidence this allegation is deemed Unsubstantiated at this time. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Feb 12, 2025 · control 29-AS-20250207164204

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(2) · Plan of correction due date: Feb 19, 2025

(h) ...(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by; Based on observation and interviews, the licensee did not comply with the section cited above, staff left unlocked lorazepam in kitchen refrigerator and kitchen medication drawer was unlocked which possessed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2025

Plan of correction: Administrator agreed to get a lock box for all refrigerated medications, provide photograph to CCL, and perform checks that the kitchen medication drawer is locked 3 times a day. Administrator will read section 87465 and provide a letter showing she understands the regulation.

Type of visit: Required - 1 Year

At 10:30am on 12/30/2024, Licensing Program Analyst (LPA) De Leon conducted an unannounced Annual visit to the facility. LPA met with Licensee Evelyn Strampe and explained the purpose of the visit. This facility is a five bedroom, 2 bathroom, living room, kitchen and dining room with a laundry room behind the kitchen some laundry and cleaning supplies were in the laundry room area not locked due to a resident wandering LPA requested a locking cabinet in the laundry room for these supplies. LPA toured of the facility, This facility has medications in locked drawers in the kitchen area all medication was checked for expiration dates, altered labels and that medication is being stored in original containers, LPA recommended a locked box for medications that needs refrigeration. Staff and Resident files are in a locked cabinet in the dining room area. Resident files were up to date with most forms and missing the updated Appraisal needs and services plans, Administrator will bring them up to date. Administrator files were missing, Administrator will make copies of records at other facility and bring them to this facility. Administrator will send any missing forms to LPA. LPA noted that there are at least two days of perishable foods and at least 7 days of non-perishable foods as well as emergency non-perishable foods. The bathrooms have liquid soap, paper towels,showers have non-slip mats and secured grab bars bare present. Facility has extra resident supplies clean linen and towels for residents use. PPE supplies are available for staffing use and visitors if requested. LPA noted that all resident bedrooms and bathroom have appropriate bedding, linen, and furniture of the resident choice. The facility has a first aid kit. The facility has dual carbon monoxide and smoke detectors. All exits and hallways are free and clear of any obstructions. LPA observed the fire extinguisher to be charged and last inspected on May 21, 2024. The facility was clean, sanitary and in good repair. Kitchen was free of rodents or insects and kept in sanitary condition. LPA reviewed staff and resident files some of the forms where missing and Administrator was completing any necessary forms with family and residents. The outside side gate has normal wear and tear and is no longer self closing or self latching and is in need of repair, Administrator will fix. The annual control tools modules were reviewed with Administrator/Licensee. Exit interview, deficiencies cited, copy of report and appeal rights printed for Licensee/Administrator.the state’s words, verbatim · CDSS document, Dec 30, 2024

The state marks this report as 55 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Uncleared individuals are present with the residents.

At 10:10am on 07/30/2024, Licensing Program Analyst (LPA) LPA Jeffries arrived unannounced to the facility. LPA met with Licensee Eveyln Strampe announced who he is and the reason for the visit. At 11:00am on 07/30/2024, LPA referred to Guardian Register a list of cleared staff for the facility and noted that the staff working during visit was identified as Staff 1 (S1) and was cleared as evidence of Guardian Roster searched on 07/30/2024. LPA interviewed Licensee Evelyn Strampe who admitted that Son (F1) has been visiting the past week from Canada who is not cleared and has been residing in empty bedroom, who has no fingerprinting and no background clearance. LPA noted that the facility will be assessed a citation for the past 5 days for having Non cleared individual residing in the facility. LPA informed Licensee that F1 will no longer be able to reside in the facility while residents are present. This admission resulted in a violation and civil penalty. Exit interview, report read, appeal rights, and report provided. Substantiatedthe state’s words, verbatim · CDSS document, Jul 30, 2024 · control 29-AS-20240729095432

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(a) · Plan of correction due date: Jul 30, 2024

87355 Criminal Record Clearance (a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. This requirement was not met by admission of Licensee, as to F1 residing in the facility for the past 5 days. Which poses a risk to residents in care.the state’s words, verbatim · CDSS document, Jul 30, 2024

Plan of correction: Licensee agrees to help proved accommodations that are not in licensed facilities for family members or individuals visiting from out of town.

Type of visit: Case Management - Other

At 8:20am on 01/05/2024, Licensing Program Analyst (LPA) Jeffries arrived at the facility to conduct an unannounced annual inspection. Upon arrival LPA was greeted at the door by Henie Cabrilla. LPA announced who he is and the reason for the visit. LPA asked for the Administrator and the Administrator was not present. LPA observed Henie Cabrilla adjust resident in chair then working the the facility kitchen, and additionally stated "I just fed the residents", when asked by LPA if he could sit at the table. LPA interviewed Henie Cabrilla while waiting for the Administrator/Licensee to arrive and discovered that Henie Cabrilla was a sibling of the Administrator and had been visiting for "about a month". Additionally, Henie Cabrilla was leaving the facility on Sunday 01/07/2024, then returning to the Philippines on 01/26/2024. LPA pulled LIS facility roster and pulled Guardian roster for this facility and Henie Cabrilla was not cleared on either roster and denied having been fingerprinted. Administrator Evelyn Strempe arrived approximately 15 minutes after LPA initially arrived at the facility. LPA notified Administrator and Henie Cabrilla that they were not cleared on the facility roster, not fingerprinted and therefore could not provide care for Residents and at all times when it the facility had to have a cleared staff present if they were visiting. Administrator and Henie Cabrilla stated that they both understood and subsequently a citation is issued. LPA continued annual facility inspection on a separate report on this same visit. Exit interview, report read, citation issued, appeal rights and report provided.the state’s words, verbatim · CDSS document, Jan 5, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g)(1) · Plan of correction due date: Jan 5, 2024

87411 Personnel Requirements - General (g) 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 by evidence of LPA observing Henie Cabrilla providing direct care to resident. Which poses a potential risk to resident in care.the state’s words, verbatim · CDSS document, Jan 5, 2024

Plan of correction: Administrator agreed to be present with visiting sibling at all times while in the facility and not allow visiting sibling to provided any direct care to residents.

Type of visit: Required - 1 Year

At 8:20am on 01/05/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual. LPA was met at the facility entrance by unknown person, not on the facility Guardian or LIS rosters, and conducted a case management visit in addition to this annual report. LPA met with Licensee Evelyn Strampe and announced the reason for the visit. This facility is a five bedroom, 2 bathroom, living room, kitchen and dining room with a laundry room behind the kitchen. LPA conducted a cursory tour of the facility, This facility has medications in the locked drawer in the kitchen area, Staff and Resident files are in a locked cabinet in the dining room area. LPA noted that there are at least two days of perishable foods and at least 7 days of non-perishable foods. LPA noted that the facility has at least 30 days of PPE on hand and all bathrooms have liquid soap and paper towels. LPA noted that the facility has 30 days of incontinent supplies. LPA noted that all resident bedrooms and bathroom have appropriate bedding, linin, and furniture. LPA noted that there is a first aide kit with all necessary kit tools. LPA noted that there is a working carbon monoxide detector and smoke detectors that are functioning throughout the facility. All exits and hallways are free and clear of debris. LPA observed the fire extinguisher to be in the green reading. LPA noted that the facility was clean and in good repair. LPA reviewed staff and resident files and found no apparent issues with facility files. The Licensee and LPA conducted a full review of the annual control tools modules. LPA noted that there were no technical, violations, or citations noted during the full review of the annual control tools modules. LPA noted that there was a case management report during the time of this visit on a separate report pertaining to Personnel Requirements, General. LPA noted that no other violations, or citations were issued on this report. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Jan 5, 2024