Viewmont Cottage

Type of visit: Required - 1 Year

At approximately 12:45 PM Licensing Program Analyst (LPA) Stevenson arrived to conducted a Annual Required inspection. There are currently no residents in care. Facility is approved/cleared for 6 non-ambulatory residents, one of whom could be bedridden. Facility has a hospice waiver for 6. Facility hasn't had any residents in care since February 2025. LPA met with Licensee Denise O'Reilly who is in the process of becoming the Administrator of Record. Facility is a two-story building with a large bonus room upstairs that will not be used by residents. LPA and licensee toured the building and grounds. All rooms were furnished per regulation. All rooms were in good repair. Extra linens were available. Water temperature in sinks were measured within the range of 105 to 120 degrees F. Fire extinguishers were charged and last tested May 2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins, sharps and other items that could pose a risk if available to residents were located in the laundry room and under the kitchen sink and found to be secured. Facility has well constructed ramps in the front and back, as well as, shade and sun areas for residents to use. Facility is noted to have several televisions, and access to games, and a sunny exercises room. A staff bathroom off the kitchen is noted to enter into a Resident's private room and licensee is advised to keep the door locked between this bathroom and private Resident room. Licensee is asked to place signs on the door banning staff from entering that staff bathroom from the private resident bedroom, as well as, using that staff bathroom door to enter the private bedroom to ensure privacy for residents in care at all times. Continued on LIC809C Continued from LIC809 LPA toured outside activity room and garage and found tools and toxins that could pose a risk to future residents were either secured or could be secured. No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 05/06/2026: 1)Updated Liability Insurance 2) Updated LIC610E (if changes) Exit interview conducted with licensee and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 7, 2026

Allegation investigated: Facility is not kept clean.

On 05/01/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of initating complaint and delivering complaint findings. LPA arrived and met with Michael Oreily, House Manager. During the investigation, LPA made observations. Compliant alleges, Facility is not kept clean. Based upon the department observations, information provided was contradicting with a lack of corroborating evidence to support the allegation. LPA made observations. Facility was clean per title 22 regulations. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 1, 2025 · control 21-AS-20250424154338

Type of visit: Required - 1 Year

05/01/2025, Licensing Program Analyst (LPA) Loera conducted an Annual Required – 1 yr. inspection visit for this facility. There are currently no residents in care. Facility approved/cleared for 6 non-ambulatory, 1 bedridden, and hospice waiver for 6. Facility hasn't had any residents in care since February 2025. LPA and House Manager toured the building and grounds. All rooms were furnished per regulation. All rooms were in good repair. Extra linens were available. Water temperature in sinks were measured within the range of 105 to 120 degrees F. Fire extinguishers were charged. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins, sharps and other items that could pose threat if available to residents were located in the laundry room and under the kitchen sink and found to be secured. No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/02/2025: LIC308- Designation of Responsibility LIC500- Personnel Report Admission Policies and Procedures/Admission Agreement Exit interview conducted with House Manager and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 1, 2025

Allegation investigated: Resident AWOL the facility with no staff supervision

Licensing Program Analyst (LPA) A. Canela arrived unannounced for the purpose of initiating complaint investigation and was greeted by care staff, April Cervantes. Administrator Angelina Simi arrived towards the end of the visit. LPA toured the inside and outside of this facility and went over allegations. It was alleged resident AWOL the facility with no staff supervision. LPA conducted several interviews with staff, resident R2 and outside source. Investigation revealed that resident R1 who is diagnosed with dementia and per interviews was an eloper, exited the facility on 11/25/2024 with no staff and went over to a neighbors home and attempted to get in. It was also disclosed R1 was observed trying to climb the facilities fence and it was also stated R1 was known by the facility to try to squeeze through the front side gate to get out. Continue report see LIC9099-C Substantiated Facility noted R1 with wondering behaviors, Dementia, Agitation and elopement precautions; yet 3 of 5 facility exit doors did not have any auditory or appropriate signal system to alert staff (one door was for R2's exit door, other 2 doors were front and side yard doors, where R1 spent time) Based on LPA observations and statement received, facility failed to ensure R1s was properly supervised and/or have appropriate preventative measures for resident R1 to exit the facility on their own. R1's medical assessment stated resident may not leave the facility unassisted. The preponderance of evidence standard has been met, therefore the allegations for Resident AWOL the facility with no staff supervision is found to be SUBSTANTIATED. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, Dec 6, 2024 · control 21-AS-20241202162205

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Dec 9, 2024

87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requiement was not met as evidenced by: Based on video clip, interviews and records reviewed: Facility did not ensure supervision of R1, who AWOL'd from the facility without their knowledge on 11/25/2024. R1's Physician's Report(LIC 602) states diagnoses of Dementia & they may not leave the facility unassisted. This is an immediate risk to the health and afety of residents care.the state’s words, verbatim · CDSS document, Dec 6, 2024

Plan of correction: Facility to send in written plan they understand regulation and how facility will ensure they meet the needs of Dementia residents. Facility to train all staff regarding Care and Supervision, AWOL procedures. Written Plan to be submitted by 12/9/2024 and staff training to be submitted to Community Care Licensing (CCL) by POC due date 12/14/2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Canela arrived unannounced and met with care staff April Cervantes, Administrator Angelina Simi arrived at the end of the visit. During the course of a complaint investigation, LPA discovered the facility failed to report an incident that occurred on 11/25/2024 when resident R1 AWOL the facility. Facility had seven days to submit a written report to Community Care Licensing. Facility had another incident on 12/2 and stated they will be submitting that report on time. During todays visit LPA also observed some gadgets on the front door, back door and office door that can be used to prevent a door from opening. LPA asked Administrator to remove those immediately even if they are stated to not being used. LPA also requested the facility to remove the front gate latch that appears to have a key hole to possibly lock. LPA explained that even if they state they are not locking it, they may not use it unless they apply with CCL and the fire department and CCL approves for a locked perimeter. During today's visit LPA also found 1 staff working S1 who was fingerprint cleared but not associated. There was an additional staff S2 who has is also employed but was also fingerprint cleared and not associated. LPA verified both have fingerprint clearances but not properly associated to this facility. LPA went over procedures and provided the facility with our Regional office information to submit requests if they are having technical difficulties with the departments Guardian link. LPA explained failure to properly associate staff may result in civil penalties being assessed, although one was not issued today. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, Dec 6, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Dec 11, 2024

Reporting Requirements- A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, This requirement was not met. As evidenced by: Facility failed to submit the 11/25/24 incident report within the required time. This is a potential risk t the H&S of residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2024

Plan of correction: Licensee/Administrator to ensure all reports as required by regulations are submitted to Licensing within required time frame. Licensee/Administrator to submit a written plan of how facility will ensure future compliance. POC due by 12/11/2024 attention LPA A Canela

From the deficiency page — Deficiency type: Type B · Section cited: CCR87355(e)(2) · Plan of correction due date: Dec 9, 2024

87355(e)(2) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. This requirement was not met. As evidenced by: Facility failed to associate staff S1 and S2 who have a fingerprint clearance but are not associated to this facility to work. This is a potential risk t the H&S of residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2024

Plan of correction: Facility to send a written plan on how they will ensure compliance and that all staff are properly fingerprint cleared and associated to the facility prior to working, residing or volunteering. POC due date 12/9/2024 attention LPA Canela

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Araceli Canela arrived to conduct a pre-licensing inspection and was greeted by Administrator, Angelina Simi and co-applicant Michael O'Reilly. At approximately 2:15PM LPA toured the building and grounds. The home is clean, organized, at a comfortable temperature with all exits free from obstruction. Facility is a two story residence with four bedrooms and two bathrooms in the first floor and an additional bedroom (staff) in the upstairs. The main level of the home is made a family room, dining room, kitchen and office. This home has a large bonus room in the yard that will be used by residents for activities and two part garage and storage room. All resident rooms are furnished per regulation with a bed, lamp, dresser, chair and bedside table. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Cleaning supplies and toxins are inaccessible to residents under the kitchen sink and sharps will be inaccessible. There was an appropriate supply of linens, hygiene products and paper products available for residents. Required postings were observed. Facility received an approved fire clearance dated February 23, 2024 by the Vallejo Fire department. Room number #3 may be used by bedridden and the other 3 rooms were approved for non-ambulatory. LPA observed charged fire extinguishers in the main home and outside in the bonus room. Smoke detectors and carbon monoxide detectors were observed. Facility has an Infection Control plan and Emergency Disaster Plan on file. Hot water temperatures found to be 108 degrees and within Title 22 Regulations of 105 to 120. No Deficiencies given during visit. Pre-Licensing inspection is complete. Component III was conducted with Administrator. LPA will then submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Statusthe state’s words, verbatim · CDSS document, May 14, 2024

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Apr 16, 2024