Ventura Villa Assisted Living

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced CASE MANAGEMENT- DEFICIENCIES visit to this facility and met with, Joy Michayluk. The case management visit is being conducted due to deficiencies observed during the investigation of complaint control # 29-AS-20260203102145. During the complaint investigation, the following deficiencies were identified: During an interview, Staff #1 (S1) stated that, during a recent Influenza outbreak, Resident 1’s (R1’s) family member requested that facility staff administer oxygen to R1 rather than have R1 transported to the emergency room. S1 stated that, based on the family member’s request, S1 contacted Staff #2 (S2) via telephone and directed S2 to administer oxygen to R1. S2 followed S1’s direction and administered supplemental oxygen to R1. S1 and S2 were identified as non-skilled professionals. Records reviewed indicated that R1 was non-verbal, diagnosed with dementia, and fully dependent on facility staff for assistance with activities of daily living (ADLs). At the time of the incident, R1 was not receiving hospice services. Further review of R1’s records revealed no physician’s order for supplemental oxygen or an oxygen treatment plan at the time of the incident. When questioned regarding the oxygen equipment used during the incident, S1 stated that the oxygen equipment had been left at the facility by a former resident, adding that the equipment had not been removed by the agency after the resident’s services had concluded. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 2, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87611(b)(2) · Plan of correction due date: Sep 3, 2026

87611(b), the licensee shall be responsible for the following: (2) Ensuring that oxygen administration is provided by an appropriately skilled professional should the resident require assistance. This requirement was not met as evidenced by: Based on interviews and records review, the licensee/administrator did not comply with the regulation above as facility staff who were not skilled professionals administered supplemental oxygen to R1 per R1’s family member request.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: The licensee write a statement of understanding on this regulation and submit to LPA prior to POC due date. Also they agree to contact an approved third party agency to conduct an in-service training with all staff regarding this regulation... and each staff member will write a statement of understanding including they are not permitted to independently initiate oxygen tratment in the absence of an authorized skilled professional. Documentation will be submitted to LPA by 9/15/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87611(e) · Plan of correction due date: Sep 3, 2026

87611(e) In addition to Sections 87465(a) and 87464(d) the licensee shall ensure that the resident is cared for in accordance with the physician's orders and that the resident's medical needs are met. This requirement was not met as evidenced by: Based on interviews and records review, the licensee/administrator did not comply with the regulation above as R1 was administered oxygen without an order from their physician.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: The licensee write a statement of understanding on this regulation and submit to LPA prior to POC due date. Also they agree to contact an approved third party agency to conduct an in-service training with all staff regarding this regulation. In-service will be submitted to LPA before POC by 9/15/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87611(b)(3) · Plan of correction due date: Sep 15, 2026

In addition to Section 87611(b), the licensee shall be responsible for the following: (3) Ensuring that the use of oxygen equipment meets the following requirements: (I) Equipment shall be removed from the facility when no longer in use by the resident. Based on interviews and records review, the licensee/administrator did not comply with the regulation above as former resident’s oxygen equipment was left at the facility after their services concluded and were used to administer oxygen to R1.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: The Licensee/Administrator will submit a statement of understanding regarding regulation cited. Licensee acknowledged information received and stated that oxygen tanks will be removed from the facility immediately once services concludes. Licensee will submitted to LPA prior to POC due date.

Allegation investigated: Staff did not meet residents' medical needs

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct subsequent complaint visit with the purpose of delivering findings for the allegation listed above. AT 10:15 A.M., LPA met with facility Lead Med Tech, Dora Islas, and explained the reason for today’s visit. Administrator, Joy Michayluk, and Office Manager, Angelica Arambulo, were contacted via telephone at 10:21 A.M and 10:51 A.M. Administrator and Office Manager were available during today's visit. Office Manager authorized Lead Med Tech to sign today's reports. Entrance interview conducted. During an initial complaint visit conducted on 02/11/2026, LPA Conway interviewed Lead Med Tech, Office Manager, Hospice Nurse, facility staff and residents. LPA also reviewed and obtained copies of documents pertinent to the investigation. Throughout the course of the investigation, LPA reviewed all documents and conducted additional interviews with relevant parties. Continued on LIC 9099-C Substantiated Continued from LIC 9099 During today's visit, a brief physical plant tour was conducted. The following was then determined: Regarding allegation of “Staff did not meet residents' medical needs” the Reporting Party (RP) alleged that during an emergency situation, emergency medical personnel were called and observed that multiple residents appeared to have required medical intervention days before the 911 call was placed. The investigation revealed that on 01/31/2026, emergency medical personnel responded to the facility during an influenza outbreak involving multiple residents. Interviews conducted with a hospice nurse revealed that upon arriving to provide services to a resident, the nurse observed the resident’s oxygen saturation level was critically low and instructed facility staff to call 911 immediately. When paramedics arrived, they observed additional residents exhibiting similar symptoms. Paramedics assessed additional residents and identified several individuals who required transportation to a hospital for further evaluation and treatment of low oxygen saturation levels and influenza-like symptoms. Interviews with facility staff indicated that changes in condition had been observed among multiple residents in the days preceding the emergency response and that management had been made aware of these concerns. Staff reported that the symptoms were believed to be consistent with a common flu illness and that the severity of the residents’ conditions, as well as the presence of an influenza outbreak, were not recognized, resulting in a delay in obtaining medical care. As a result, medical evaluation and treatment were not obtained until emergency responders were contacted. Based on interviews conducted, records reviewed, and documents obtained during the investigation, the allegation of “Staff did not meet residents' medical needs” is deemed Substantiated. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 16, 2026 · control 29-AS-20260203102145

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jun 17, 2026

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as the facility did not provide appropriate timely care for several residents during an influenza outbreak which posed an immediate health concern to clients in care.the state’s words, verbatim · CDSS document, Jun 16, 2026

Plan of correction: Facility will conduct an in-service training provided by a third-party vendorship that is approved by the Department with all staff including management about the importance of noticing the signs/symptoms of illness and seeking appropriate medical attention in a timely manner. This training shall be schedule by POC due date and proof shall be submitted to LPA and proof of the completed training will be sent to LPA once training is conducted.

Allegation investigated: Insufficient staffing

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct subsequent complaint visit with the purpose of delivering findings for the allegation listed above. At 10:15 A.M., LPA met with facility Lead Med Tech, Dora Islas, and explained the reason for today’s visit. Administrator, Joy Michayluk, and Office Manager, Angelica Arambulo, were contacted via telephone at 10:21 A.M and 10:51 A.M. Administrator and Office Manager were available during today's visit. Office Manager authorized Lead Med Tech to sign today's reports. Entrance interview conducted. During an initial complaint visit conducted on 02/11/2026, LPA Conway interviewed Lead Med Tech, Office Manager, Hospice Nurse, facility staff and residents. LPA also reviewed and obtained copies of documents pertinent to the investigation. Throughout the course of the investigation, LPA reviewed all documents and conducted additional interviews with relevant parties. Continued on LIC 9099-C Unsubstantiated Continued from LIC 9099 During today's visit, a brief physical plant tour was conducted. The following was then determined: Regarding allegation of “Insufficient staffing” the Reporting Party (RP) alleged that facility did not have a nurse on site, residents were left unattended during a medical emergency. And staff were unable to provide emergency responders with essential resident information. The investigation revealed that the facility is licensed as a non-medical Residential Care Facility for the Elderly (RCFE) and is not required to maintain a nurse on site. During an interview, the Office Manager stated that at the time of the incident there were two (2) caregivers on duty, in addition to a hospice nurse who was present to provide services to a resident. Interview with staff indicated that when the medical emergency occurred, Staff #1 remained with emergency responders and assisted paramedics by providing documentation and information about the residents, while Staff #2 (S2) continued providing care and supervision to other residents within the facility. Staff denied living residents unattended. A review of staff timecards confirmed that two (2) caregivers were on duty at the time of the incident. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation. therefore, the allegation of “Insufficient staffing” is deemed Unsubstantiated at this time. No citations issued. Copy of the report provided.the state’s words, verbatim · CDSS document, Jun 16, 2026 · control 29-AS-20260203102145

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced Case Management – Incident inspection pertaining to a self-reported Special Incident Report (SIR) received on 05/21/2026. At 10:15 A.M., the LPA met with facility Lead Med Tech, Dora Islas, and explained the reason for today’s visit. Administrator, Joy Michayluk, and Office Manager, Angelica Arambulo, were contacted via telephone at 10:21 A.M and 10:51 A.M. Administrator and Office Manager were available during today's visit. Office Manager authorized Lead Med Tech to sign today's reports. Entrance interview conducted. The self-reported SIR pertains to a medication error that occurred on 05/16/2026 involving nine (9) residents. According to the SIR, at approximately 7:00 A.M., caregivers administered resident’s bedtime medications instead of their scheduled morning medication. Upon discovering the error, the Med Tech (MT) who arrived at approximately 8:00 A.M., administered the correct morning medication. The SIR indicates that Staff #1 (S1) and Staff #2 (S2) were reprimanded and an in-service medication training was provided following the incident. Interview with Lead Med Tech revealed that medication had been pre-popped in advance and the morning caregivers mistakenly selected and administered the bedtime medication set. During the visit, the LPA requested documentation verifying that the in-service training had been conducted, however, documentation was not available to support completion of the training. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted, today's reports and appeal rights were reviewed and issued to Lead Med Tech.the state’s words, verbatim · CDSS document, Jun 16, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(5) · Plan of correction due date: Jun 17, 2026

Incidental Medical...(h)The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Based on SIR and interviews, medication was removed from its original container in advanced causing staff to dispense the PM medication instead of the AM in error to residents in carethe state’s words, verbatim · CDSS document, Jun 16, 2026

Plan of correction: Facility will conduct an in-service training provided by a third-party vendorship that is approved by the Department with all staff including management about the importance of not pre-sorting medications along with providing a signed statement with all staff. This training shall be schedule by POC due date and proof shall be submitted to LPA and proof of the completed training will be sent to LPA once training is conducted.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual inspection. At 10:15 A.M., LPA met with facility Lead Med Tech, Dora Islas, and explained the reason for today’s visit. Administrator, Joy Michayluk, and Office Manager, Angelica Arambulo, were contacted via telephone at 10:21 A.M and 10:51 A.M. Administrator and Office Manager were not available during today's visit. Office Manager authorized Lead Med Tech to sign today's reports. Entrance interview conducted. LPA, along with Lead Med Tech, toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. Lead Med Tech was unable to provide documentation regarding annual fire inspection. LPA tested the carbon monoxide detector which functioned properly during the visit. Fire extinguishers appeared fully charged and were last serviced on 06/01/2026. RESIDENT ROOMS/RESTROOMS: Resident rooms are either single or double occupancy. Eight (8) occupied resident rooms were observed during today's visit and contained the appropriate furnishings, linens, and bedding. LPA observed bed rails that extended the entire length of the bed of Resident’s #1 (R1’s). Per Lead Med Tech, R1 is not receiving hospice services. Technical Violation (TV) issued. Resident restrooms are jack-and-jill style - shared between 2 adjacent rooms. Six out of eight restrooms observed were not stocked with toilet paper, paper towels, or soap. LPA tested the hot water temperature in all occupied rooms. During the inspection, LPA observed that the sink in Room# 305 did not deliver hot water. Additionally, the hot water temperature in room #407 and #408 A&B were below the regulatory requirement. LPA further observed that the sinks in room #408 and #204 did not drain properly causing water to accumulate in the basin. Continued on LIC 809-C Continued from LIC 809 COMMON AREAS: Laundry room was inaccessible to residents during today’s visit. The facility has shower rooms for residents with non-slip surfaces when wet. LPA did not observe slip-resistant mats in the shower rooms. At 3:32 P.M. LPA observed that the delayed egress system installed at the facility's main entrance was not functioning properly. KITCHEN/DINING ROOM: The dining room was properly furnished and is also utilized as an activity area. The facility had a sufficient supply of food (perishable and non-perishable). Kitchen appliances appeared functional. During today’s visit the facility did not have a supply of emergency water. BUILDINGS AND GROUNDS: This facility is fully fenced and has a fire clearance for secured perimeter. There is covered seating on the patio for residents' use. During today’s visit LPA obtained a copy of the facility’s LIC 500 and resident roster. A copy of an old liability insurance was provided; Lead Med Tech did not have access to the current documentation. Due to time constraints LPA will return at a later date to conduct medication review record review. During today’s visit LPA informed the lice Lead Med Tech that removing medication from their original packaging in advance of administration (pre-popping) is not permitted. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of today's report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 16, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced Case Management - Other visit in conjunction with a complaint visit (Complaint control # 29-AS-20260203102145.) The LPA was greeted by lead Med Tech Dora, Islas and informed them of the reason for the visit. At 2:45 PM, Office Manager, Angelica Arambulo arrived at the facility, however they were unable to sign today's report. Office manager authorized lead Med-Tech to sign today's report. Entrance interview conducted. On 02/02/2026, LPA Conway received a telephone call from a Public Health official requesting information regarding an influenza outbreak at the above facility. The Public Health official stated that the Department of Emergency Services had notified them that four (4) residents from the facility were transported to the hospital and diagnosed with Influenza. The Public health official further stated that attempts to contact the facility’s administrator to obtain additional information were unsuccessful. The first incident report submitted to Community Care Licensing (CCL) was received on 02/03/2026, after Public Health contacted the facility. The incident report submitted by the facility reported that four (4) residents were sent to the hospital due to flu-like symptoms and that Resident #1 (R1) passes away on 02/02/2026. As of 02/11/2026, CCL had not received a death report for R1. On 02/06/2026, LPA Conway contacted the facility office manager by telephone. The office manager confirmed that several residents and staff members had been experiencing flu-like symptoms since 01/25/2026, and acknowledge that by Saturday, 01/31/2026, the facility was experiencing an influenza outbreak. Despite this knowledge, the office manager failed to notify CCL and local health officer within 24 hours of the outbreak by telephone of facsimile. Additionally, they failed to report the death of R1 within seven (7) days from the date of occurrence, as required. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 11, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a) · Plan of correction due date: Feb 12, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: This requirement is not met as evidenced by: Based on interview conducted and records reviewed, the licensee did not comply with the section cited above as they did not submit an outbreak incident report within 24 hours and a death report within seven (7) days which poses an immediate health and safety risk to resident(s) in care.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: Office Manager will write a statement of understanding on regulation 87211 and submit all pending incidents to LPA before PCO due date,

Allegation investigated: Facility was unable to provide power to residents during power outage Facility did not designate substitute staff during administrator’s absence Facility did not have an up-to-date and readily available emergency disaster plan Staff did not ensure that residents had hot water Staff are unable to communicate with residents due to language barrier

Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced subsequent complaint investigation visit. LPA arrived at the facility, met with Medication Technician Dora Islas and explained the reason for the visit. Administrator and House Manager were not at the facility. On 1/21/2025, LPA conducted an initial complaint investigation visit at the facility. LPA conducted an interview with staff and collected information and documents from the House Manager. During today’s visit, starting at 10:26 a.m. LPA conducted interviews with four staff and a visitor. LPA also conducted a facility tour at 10:58 a.m. (continued on LIC9099C) Unsubstantiated (continued from LIC9099) Regarding the allegation “Facility was unable to provide power to residents during power outage”: This allegation was regarding a power outage that occurred on 1/13/2025, when Edison conducted a Public Safety Power Shutoff (PSPS) in the area due to fire danger. The power went off at approximately 5:00 a.m. At approximately 7:00 a.m. medication technician Dora Islas (Islas) arrived at the facility. Staff were using flashlights at the time. Most of the residents were still asleep. Islas turned on the generator when she got in. The facility generator powers emergency lighting in the rooms (overhead light), lighting in the hallway, and refrigerators/freezers. The house manager purchased battery operated lanterns for residents’ bathrooms. Natural gas was working in the facility, so they were able to use the stove and oven. The natural gas hot water heaters were also working. There are some areas of the facility where it takes more time for the water to heat up, but it does heat up. Staff also provided extra blankets to residents who needed them. Any residents who usually use additional items to keep warm, such as electric blankets or space heaters, were provided with extra blankets. The power was restored at 10:00 a.m. on 1/14/2025. The visitor who was interviewed did not recall the power outage. Based on interviews, this allegation is deemed unsubstantiated at this time. Regarding the allegation “Facility did not designate substitute staff during administrator’s absence”: In the hallway near the entry to the facility next to the front desk, the facility has photos up of the care staff and management team. The administrator, assistant administrator and house manager are all displayed on the bulletin board along with the care staff. If nobody from the management team is at the facility, the medication technician will step in to oversee the operation of the facility. The facility has also filed a Designation of Responsibility with Community Care Licensing. Based on interviews and records reviewed, this allegation is deemed unsubstantiated at this time. Regarding the allegation “Facility did not have an up-to-date and readily available emergency disaster plan”: The facility emergency disaster plan is located in the staff office which all staff have access to. The disaster plan is current and complete. When LPA requested to see the disaster plan, it took one minute for medication technician Dora Islas to locate it. Based on interviews and records reviewed, this allegation is deemed unsubstantiated at this time. (continued on LIC9099C) (continued from LIC9099C) Regarding the allegation “Staff did not ensure that residents had hot water”: This allegation was specifically regarding the hot water in the room belonging to Resident 1 (R1). According to staff, the facility’s natural gas was still working during the power outage of 1/13/2025 so the facility still had hot water and the ability to cook. R1’s bathroom sink has a small tankless water heater that uses electricity because R1’s representatives complained it took too long for the water in the sink to heat up. During the power outage that small electric water heater did not work. However, the gas water heaters for all facility plumbing were working, it just took a little more time for the water to heat up. Based on the information gathered from interviews, this allegation is deemed unsubstantiated at this time. Regarding the allegation “Staff are unable to communicate with residents due to language barrier”: The staff interviewed by LPA stated there are some staff working at the facility that do not speak fluent English. Those staff have been instructed on how to use a translation application on their cell phones. In addition, the administrator or house manager make sure there is an English speaking staff scheduled at all times at the facility. The visitor LPA interviewed stated they have problems communicating with certain staff, however they can go to other staff or the administrator if they need to communicate something. Based on these interviews and records reviewed, this allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report provided to the facility.the state’s words, verbatim · CDSS document, Jul 7, 2025 · control 29-AS-20250114102924

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual inspection. LPA met with Operations Manager Angelica Arambulo and explained the reason for the visit. LPA, along with the Manager, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility's last fire inspection was completed on 1/28/2025 with no concerns noted. LPA tested the carbon monoxide detector which functioned properly during the visit. Fire extinguishers appeared fully charged and were last serviced 12/2024. RESIDENT ROOMS/RESTROOMS: Resident rooms are either single or double occupancy. 10 (ten) resident rooms were observed during today's visit and contained the appropriate furnishings, linens, and bedding. Resident restrooms are jack-and-jill style - shared between 2 adjacent rooms. Restrooms observed were clean and sanitary in operating condition. Water temperature was tested in a sample of resident restrooms and measured at 106.1 degrees Fahrenheit which is within the required range of 105*F-120*F. COMMON AREAS: Laundry room door lock was broken at the time of the visit. Laundry detergent was observed to be accessible in the laundry room. The facility has shower rooms for residents with non-slip surfaces. LPA observed the surfaces were not non-slip when wet. The Manager stated they would get non-slip mats for the shower rooms. KITCHEN/DINING ROOM: The dining room was properly furnished and is also utilized as an activity area. The facility had a sufficient supply of food (perishable and non-perishable) and water. Kitchen appliances appeared functional. (continued on LIC809-C) (continued from LIC809) BUILDINGS AND GROUNDS: This facility is fully fenced and has a fire clearance for secured perimeter. There is covered seating on the patio for residents' use. STAFF: LPA spoke with three (3) staff; there were no concerns noted. LPA reviewed five (5) staff files and all were complete. Documents reviewed included, but were not limited to, training records, TB test results, health screenings, and fingerprint background clearance. RESIDENTS: LPA attempted interviews with residents, however due to cognitive decline was not able to complete the interviews. LPA reviewed five residents' files and all were complete. Documents reviewed included, but were not limited to, physician's reports, admission agreements, personal rights, and needs and services plans. MEDICATIONS: LPA reviewed medications which are stored in the locked medication room. The facility utilizes Medication Administration Records (MAR) to ensure medications are given correctly. The facility has Centrally Stored Medication and Destruction Records (CSMDR) created by the pharmacies, however the start dates for medications were not transferred to these forms. The Medication Technician was informed these dates must be transferred to the CSMDR. Otherwise, the medications reviewed appeared to be given as prescribed and the medications were properly labeled. The first aid kit is also stored in the locked medication room. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of today's report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 23, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff inappropriately touched residents in care

On 01/17/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint investigation visit to the facility above. LPA arrived at the facility, met with Direct Support Staff Catalina Gonzalez in person and Operations Manager Angelica Arambulo by telephone as the administrator was unavailable, and announced the purpose of the visit. On the allegation: Staff inappropriately touched residents in care. It is alleged that a facility staff, Staff #1 (S1), has been sexually abusing and inappropriately touching Resident #1 (R1) and other residents in the facility. The Reporting Party (RP) stated that they were informed of this allegation by Witness #1 (W1), but it was unknown how W1 learned this information. The names of the alleged victims were not known, and it was unknown if there were any witnesses to corroborate the allegation. Interviews conducted by the Licensing Agency with Witness #1 (W1) could not confirm the allegation and W1 was not able to specifically identify the concerns that were allegedly reported. Continued on 9099-C Unsubstantiated W1 stated that they did not witness Staff #1 (S1) or any Staff behave indecently toward Resident #1 (R1) or other residents in care. Furthermore, W1 denied that staff reported that they witnessed S1 sexually abuse any residents. An interview with R1 did not reveal that they were sexually abused and R1 denied that they were inappropriately touched by any staff. No information was found by the Licensing Agency Investigations Branch (IB) to warrant a full investigation. The Reporting Party (RP) stated to the Licensing Agency that Resident #1 (R1) has not disclosed any sexual abuse to them but noted that R1 is mentally disabled and not capable of articulating due to a diagnosis of dementia. When interviewed, R1 did not express that any of the staff made them feel uncomfortable or unsafe. They also denied that any of the staff made them feel threatened or intimidated. R1 denied that any of the staff touched them inappropriately. R1 was asked if they knew the staff member, S1, named in the allegation and R1 stated that yes, they did know S1 but there was no problem with them. R1 did not remember the last time they saw S1. R1 denied that S1 made any sexual gestures toward them while they were around each other. All other residents in care at the facility interviewed by LPA stated that no staff member has made them feel threatened or intimidated. Residents stated to LPA that no staff member has physically touched them in an inappropriate way or made any type of sexual movement/gesture. Based on the information gathered, there is insufficient evidence to prove Staff inappropriately touched residents at the facility. Therefore, the allegation is Unsubstantiated. Exit interview conducted. Copy of this report provided to the facility.the state’s words, verbatim · CDSS document, Jan 17, 2025 · control 29-AS-20240603180222

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. Upon arrival, LPA met with Operations Manager Angelica Arambulo. Entrance interview conducted. At 01:27PM, the LPA, along with facility staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: RECORD REVIEW: LPA reviewed staff and resident files for documents including, but not limited to: physician's report, Admission Agreements, personal rights, staff fingerprint background clearance, TB test results and health screenings. 1 (one) staff (Staff #1 - S1) did not have proof of fingerprint background clearance, but has been working for the facility since April 2024. Additional items observed will be addressed during the annual continuation visit. RESIDENT ROOMS/RESTROOMS: Resident rooms are either single or double occupancy. 10 (ten) resident rooms were observed during today's visit and contained the appropriate furnishings, linens, and bedding. Resident restrooms are jack-and-jill style - shared between 2 adjacent rooms. Restrooms observed were clean and sanitary in operating condition. Water temperature was tested in a sample of resident restrooms and measured at 86.4 degrees Fahrenheit in one resident restroom. Other remaining resident water temperatures were within the required range. COMMON AREAS: Laundry room door lock and staff room door lock were observed to both be broken at the time of the visit. Laundry detergent was observed to be accessible in the laundry room and staff belongings, which included visible medications, among other personal belongings were also accessible to residents in care. Report Continued on LIC 809-C BUILDINGS AND GROUNDS: During facility tour, LPA noted that all exterior gates are padlocked and/or chained and locked. Facility staff stated that the cameras were being repaired and in the meantime, gates were locked for resident safety. Operations Manager stated that if the gates are locked, this should be approved in the fire clearance. Review of facility plan of operation and fire clearance documents are unclear whether locked perimeter is approved. Further investigation is needed to determine if a violation occurred. LPA will address this during the annual continuation visit. Due to time constraints, LPA will return at a later date to continue the annual inspection. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. A $500 civil penalty was assessed. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of today's report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 5, 2024

Allegation investigated: Staff are not properly trained to administer residents’ medications.

Licensing Program Analyst (LPA), Esther Cortez conducted a subsequent complaint visit for the above allegations. Upon arrival, LPA met with staff and was explained the reason for the visit. Office Manager Angelica arrived at the facilty at approximately 12:00 p.m. On 1/09/2024, between 03:30 p.m. and 4:55 p.m., the LPA interviewed the Office Manager, staff, two residents, and obtained copies of resident records and other pertinent documents relevant to the investigation. During today's inspection, between 10:15 a.m. and 5:30 p.m., the LPA conducted a file review, interviewed the Office Manager, staff, residents, conducted a tour of the physical plant and obtained copies of resident records and other pertinent documents relevant to the investigation. Report will contiue on LIC9099-C. Substantiated It is alleged that the ‘Staff are not properly trained to administer residents’ medications. The concern of the RP is that employees are asked to give medicines to residents, but the employees are not certified to pass the medicine. To investigate the allegation LPA Cortez interviewed staff, the Office Manager, and conducted a file review. Staff interviews revealed that caregivers pass out medications to residents when there is no MedTech (MT) available. The Administrator stated that the caregivers who pass out medications to residents when the MedTechs are not available have been trained by one of the facilities MedTechs on how to pass the medication. However, there was no documentation on medication training available for the LPA to review for the caregivers that are passing out medications. On 1/09/24, during the initial 10-day complaint visit the Office Manager provided the LPA a certification of completion of 24 hours medication training program for four (4) MedTech’s at the facility. One out of the four MT’s no longer works at the facility. Furthermore, the certificates do not have any additional information other than the instructor’s signature. The Administrator stated that a pharmacist had come out to give the medication training, however could not provide additional information of the consultant such as the address, and telephone number of the consultant, the date when consultation was provided, the consultant’s organization affiliation, if any, and any educational and professional qualifications specific to medication management and, the training topics for which consultation was provided. Based on the information gathered through the interviews and documentation the allegation is Substantiated at this time. During the visit Office Manager Angelica Arambulo left the facility and assigned MedTech Dora Islas to review and sign the report. Per California Code of Regulations (CCR), Title 22, see LIC 9099-D for deficiencies cited. . A copy of the report was issued, along with appeal rights. It is alleged that a ‘Resident sustained unexplained bruising’. The concern of the RP is that a resident sustained bruising and the RP does not think anyone reported this information. During this investigation LPA Cortez conducted interviews with Resident #1, facility staff, and a family member of the resident. In addition, R1’s medical records and facility records were reviewed. Information revealed that R1 had an un-witnessed fall in the room on 10/20/23, was taken to hospital for evaluation. Facility submitted an Unusual Incident/Injury Report (LIC624) to CCL on 10/22/23. R1 was diagnosed with a fall, contusions, facial hematoma, and dementia. The bruises could be from that fall. The general information also states the risk of falling is higher in older people, R1 ambulates most of the time. During LPA's interview with R1, it was learned that R1 is confused and cannot hold a conversation. There is no indication or evidence identified that R1 may have been physically abused. Interview with R1's family indicates that they are happy with the care being provided to R1 and have no concerns at this time. R1 is still residing at the same facility. Based on the information gathered through the interviews and file review there is insufficient evidence to support the above allegation. Therefore, although the allegation may have happened, or may be valid, this allegation is deemed Unsubstantiated at this time. It is alleged that the ‘Facility is not supplying adequate food service’. The concern of the RP is that residents are not being provided snacks at night when asked for and are given hard bread. LPA Cortez interviewed residents, staff, and Office Manager, and conducted a tour of the kitchen. Interview with residents revealed that residents are being provided with snacks if requested. Residents stated that they also have snacks in their rooms. Interviews with facility staff revealed that snacks are available for residents such as fruit, yellow, and yogurt. Furthermore, staff stated that sandwiches and other items such as apple sauce are left in the staff refrigerator at night in case there’s residents that request food after the kitchen is closed. Interview with the Office Manager revealed that residents are provided with three meals a day, and two snacks, and additional snacks during activities. The administrator also stated that most residents don’t typically ask for food at night, however that staff is aware of what residents may be up at night wondering and have snacks available for them. During the tour of the kitchen, the LPA observed the refrigerator stocked with vegetables, fruit, yogurt, ice cream, milk, juice, and other foods. The freezer was stocked with frozen meats, and other frozen foods. Based on the information gathered through the interviews and observations there is insufficient evidence to support the claim that residents are not provided with adequate food service. Therefore, although the allegation may have happened, or may be valid, this allegation is deemed Unsubstantiated at this time. Report will continue on LIC9099-C... It is alleged that the ‘Staff failed to provide a comfortable environment for residents’. The concern of the RP is that residents wear bibs to clean their faces, but when they do the laundry, they wash the bibs with the mop's rugs, and that residents are dressed in clothes not appropriate for the weather. Furthermore, it was alleged that resident #2 always gets cold water in the house. To investigate the allegation LPA Cortez interviewed residents, staff, and conducted a tour of the laundry room and R2’s room. Residents stated that they are treated well at the facility and have no concerns. Staff interviews revealed that bibs are not washed with the mop’s rugs and that residents are dressed in sweaters and jackets during the cold weather. The LPA observed residents wearing sweaters/jackets and observed some residents also with blankets. During the tour of the laundry room, the LPA observed bibs in the washing machine, however the LPA did not observe any mop’s rugs in the washing machine with bibs. Lastly, at 1:18 p.m. the LPA measured the hot water in R2’s restroom at 115.5 degrees Fahrenheit. Based on the information gathered through the interviews and observations there is insufficient evidence to support the above allegation. Therefore, although the allegation may have happened, or may be valid, this allegation is deemed Unsubstantiated at this time. During the visit Office Manager Angelica Arambulo left the facility and assigned MedTech Dora Islas to review and sign the report. Exit interview conducted and report was issued.the state’s words, verbatim · CDSS document, Jan 25, 2024 · control 29-AS-20240103113700

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69 · Plan of correction due date: Feb 8, 2024

§1569.69(a) (1) In facilities licensed to provide care for 16 or more persons, the employee shall complete 24 hours of initial training. This training shall consist of 16 hours of hands-on shadowing training,...and 8 hours of other training or instruction,... This requirement is not met as evidenced by: Based on interviews, the licensee failed to comply with the section cited above as caregivers without complete medication training are passing medications, & training consultants inormation was not available which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 25, 2024

Plan of correction: Administrator will provide a Statement of Understanding of the regulation 1569.69 and write a commitment/plan to ensure staff will not assist with medication management until they are fully trained. And provide the Pharmacist consultants information, who trained the MTs, to LPA by 2/08/24.