Villa Anne

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 8:30 AM, LPA met with Licensee/Administrator Stephanie Figueros. An initial application for Change of Ownership to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 04/15/2025 for a total capacity of six (6); five (5) non-ambulatory and one (1) bedridden residents. Fire clearance was granted on 3/5/2025. LPA Delgado observed the following: Structure: Facility was a one-story house with four (4) resident bedrooms, two (2) resident bathrooms, living room, dining area, kitchen and staff room. There was an attached two car garage in the front of the house. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house. Bedrooms: Each resident bedroom #1-private, #2-shared, #3-private room will accommodate non-ambulatory and #4 is a shared room will accommodate 1 non-ambulatory and 1 bedridden resident. Four (4) resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: The two(2) resident bathrooms has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. (Continued on Page 2) (Continued from Page 1) At 10:11 AM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 110.1 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be non-operational. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located inside the house. Laundry detergents and cleaning supplies were observed in a locked closet away from residents. Living/Family room: There was a living/family room with seating for all clients and TV. Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies was stored in a cabinet in the main hallway of the residence. Yards/Outside: Patio table and chairs were observed in the backyard. There was a gate on the South side and North side of the property. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the main hallway and resident bedrooms. Obudsman poster and Let-Us-No poster observed. General items: One (1) fire extinguishers were charged and located in the kitchen. Ten (10) smoke alarms and three (3) carbon monoxide detectors were tested and were observed to be in working order. Client records will be stored in a locked cabinet in the Family room. First Aid kit with required components, and locked area for medication storage was observed. Additional refrigerator/freezer inside garage. LPA observed a facility phone and it was verified to be operational as evidenced by LPA dialing the number to trigger a ring. Emergency water and 72-hour emergency food supply was observed. Component III was completed on July 8, 2025 in the Riverside Regional office. (Continued on Page 3) (Continued from Page 2) Pre-Licensing is incomplete and the following corrections to be resolved by 9/22/2025: add the use of cameras in common areas on Plan of Operation and Admission agreements obtain screen for sliding door Room #4 obtain hallway light for common bathrooms obtain 11th edition for First Aid Manual remove metal pieces from the exterior ground in front of Room #4 repair stove pilots Update facility sketch to reflect bedridden room and email to CAB analyst. An exit interview was conducted Stephanie Figueros, and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 25, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Stephanie Figueros (Managing Member/Administrator) Interview Method: Virtual interview via Microsoft Teams On May 29, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 29, 2025