Villa-Care Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melisa Rankin arrived at 11:44 a.m. to conduct a 1-year required annual visit. LPA met with Jennifer Villaros, Administrator. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: LPA toured resident rooms and observed that rooms were tidy and free of odor. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have slip resistant mats/flooring. The pathways are clear of any obstructions. Disinfectants and cleaning solutions are inaccessible to residents in care and locked in closet. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for residents’ use. The fire extinguisher was last charged and inspected on 12/8/25. The facility has smoke and carbon monoxide detectors that were tested and working properly. Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with resident rooms in regard to the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory residents and 1 bedridden resident. The facility currently has 5 residents. Continued on 809-C Staffing, Personnel Records & Training: The facility currently employs 9 staff which rotate coverage and has 2 administrators who also provide caregiving coverage. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator Certificate expires on 8/14/27. Staff have annual training completed for various subjects/topics and hours for 2025. Medication training was completed. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms. All forms were legible, all records complete. Food Service:. The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. The kitchen is clean and sanitary. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, PRN medication process is being updated, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill/training in December of 2025. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility has 1 self-latching gate on side of the home. The facility does not have delayed egress, locked doors or gates. Exit door alarms are present and working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Feb 2, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Rankin returned on 4/2/25 to conclude the required 1-year annual visit to the facility above. LPA met with Licensee/Administrators Jennifer Villaros and Jessica Rust explained the purpose of the visit. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 04/28/2025. Outdoor Facilities: LPA noted on last visit part of the concrete in the backyard had a crack which was concerning as a trip hazard, since the March visit, facility has had a company come in and shave down the concerning area. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does have one (1) resident with oxygen. There are two (2) residents on hospice. There are no residents receiving home health services at this time. No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.the state’s words, verbatim · CDSS document, Apr 2, 2025

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin conducted a 1-year annual visit to the facility above. LPA met with Licensee/Administrators Jennifer Villaros and Jessica Rust and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with the Administrator. The following was inspected and noted during the annual visit: PHYSICAL PLANT & ENVIRONMENTAL SAFETY: The facility has five (5) resident bedrooms and two (2) resident bathrooms. There is an approved fire clearance capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility has an approved Hospice Waiver for six (6) residents. The showers have non-skid floors. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked in cupboards. The facility has sufficient space inside and outside for activities and visiting. This is a two (2) story facility in which the first floor is for residents in care at the facility and the second floor is specifically for Staff members. The second story is inaccessible and off limits to residents of the facility. The first-floor indoor areas of the facility consist of resident bedrooms, restrooms, shower areas, a Centrally Stored Medication area, kitchen, dining room, storage area closets/rooms, living room, family room, staff office area and an entrance area upon entry into the facility. All resident bedrooms were furnished and contained beds, chairs, bedside tables, and lamps. There is also an ample supply of linens and towels. LPA observed night-lights present in the main bathroom, kitchen, and family room. The facility contains an outside area for residents to utilize for outdoor activities/outdoor visitations and an outdoor patio area with furniture and shade. There is a locked tool shed in the backyard of the facility. The shed contained outdoor maintenance materials for the facility. The facility has carbon monoxide detectors which were tested and were working at time of visit. Fire extinguishers were observed charged and inspected last on 12/11/24. The facility is clean, safe, and sanitary. Continued on 809-C FOOD SERVICE: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. All food is covered and stored. Emergency supply of food and water is available. Kitchen areas are kept clean and free of insects and rodents. LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in a locked drawer inaccessible to residents of the facility. There was emergency food and water in the garage of the facility. PERSONNEL RECORDS & TRAINING: The facility employes seven (7) staff and three (3) Administrators. Staff records are kept confidential. LPA reviewed five (5) staff files for 1st AID/CPR, Fingerprint clearances, Applications, Health exam with TB results, and Criminal Record statement. Administrator certificate expires 08/14/25. Annual training was complete. RESIDENT RECORDS & INCIDENT REPORTS: The facility keeps confidential files on each resident. Five (5) files were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, and Personal Rights. All records were complete. Facility does submit incident reports to the department when required. MEDICATIONS: The facility maintains a locked centralized storage area for resident medications. Centrally Stored Medications are in a locked storage containment area within an indoor closet area of the facility. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record. The medications in the facility were labeled appropriately with no additional or prohibited marking's by the facility. FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exit plans with necessary telephone numbers. The facility keeps posted copies of facility documentation such as the RCFE License Certificate, LIC 500 Personnel Report, Documentation of Facility Waivers, Emergency Disaster Plan for Residential Care Facilities for the Elderly (RCFE), Certificate of Liability Insurance, Valid Administrator Certificate, and a Facility Sketch. No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Required - 1 Year

On 03/27/2024, Licensing Program Analyst (LPA) Brian Phillips arrived unannounced for an unscheduled visit to conduct a required Annual site inspection visit at the facility above. When the LPA arrived, they were greeted by Administrator Jennifer Villaros and On Call Staff Member Jessica Rust, and informed them of the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This is a Residential Care Facility for the Elderly (RCFE), with an approved fire clearance capacity of Six (6) Non-Ambulatory residents, of which One (1) may be bedridden. The residents have an age range of sixty (60) years of age and older. The facility has an approved Hospice Waiver for Six (6) Residents. This is a Two (2) story facility in which the first floor is for residents in care at the facility and the second floor is specifically for Staff members. The second story is inaccessible and off limits to residents of the facility. The facility contains an outside area for residents to utilize for outdoor activities/outdoor visitations and an outdoor patio area with furniture and shade. KITCHEN: The facility kitchen is an open style area which has an opening into a dining room area and views the family room area. The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in a locked drawer inaccessible to residents in the garage of the facility. Kitchen appliances were in operable condition and looked clean/in good repair. The LPA observed perishable items in good condition, with proper expiration dates precluding the perishable items from expiring. The facility has a sufficient supply of perishable and non-perishable food, which would last over a week (7 days). The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation between 105-120 degrees Fahrenheit. Items that could constitute a danger to residents are kept inaccessible to residents outside of the kitchen area. The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. The freezer/refrigerator were both appropriate temperatures for the storage of food and prevention of spoiling. Continued 809-C There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. The kitchen contained a sufficient supply of dishes, glasses and utensils. There is space to lock chemicals under the kitchen sink. COMMON AREAS: The facility is two stories and separates the Staff only areas from the resident common areas by floor. The first-floor indoor areas of the facility consists of resident bedrooms, restrooms, shower areas, a Centrally Stored Medication area, kitchen, dining room, storage area closets/rooms, living room, family room, Staff office area and an entrance area upon entry into the facility. At the time of the visit, the common areas of the facility were observed to be appropriately furnished, with all furniture in good condition. There are no fireplaces in the facility, and the facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector(s) were operational at the time of the visit. The facility has a fire extinguisher that was fully charged and serviced annually, being tagged as serviced in 2024. This facility contains a locked centrally stored medication containment area which is a locked closet, extra storage areas for additional perishable food, closets/rooms in the hallways of the facility containing extra linen/bedsheets/pillows, and storage areas for resident personal hygiene equipment constituting the interior areas of the facility. The LPA observed required postings throughout the common spaces including Resident Personal Rights and Contact information for Ombudsman as well as Licensing. There are activity supplies and equipment, including activity materials for the residents such as television, puzzles, games, etc. All window screens were in good repair. There is appropriate lighting in the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and all inclines are well-lit with no stairwells/stairs for resident use. The laundry area for the facility is located in the garage of the facility that is inaccessible to residents. There is a main entrance walkway into the facility and an administrative entrance area for visitors. The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors, and walls are in good repair. The second floor of the facility is up a set of stairs and is only for Staff members of the facility. It is inaccessible and off limits to residents. There are three (3) Staff member bedrooms and one (1) Staff member restroom on the second floor of the facility for live in caregivers and/or Staff members working overnight. OUTSIDE/LAUNDRY/MISCELLANEOUS: The front outdoor area of the facility consists of cement walkways and grass areas. The facility outdoor front yard area is paved with a walkway up to the front door of the facility. The back yard has a patio with shade and outdoor furniture conducive for outdoor visitation. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The exterior of the facility has a closed perimeter which consists of a fence around the backyard area of the facility. Contd 809-C Inside of the perimeter is the outdoor/outside activity area for residents with a patio in the backyard, furniture, shade. The facility has an outdoor activity area that is provided with a shaded area and furnished for outdoor use. There are no bodies of water noted on the facility property. The designated laundry area is in the garage of the facility, which is also the area where locked storage of cleaning products and any toxins/chemicals that could constitute a danger to residents are stored, which are kept locked and inaccessible to residents. Staff members are the only individuals allowed to do laundry and the garage is inaccessible to residents. There was emergency food and water in the garage of the facility and in the extra perishable food storage area which was observed to be in good condition. Cleaning supplies, disinfectants, and other items that could pose a danger to residents are kept in areas inaccessible to residents. There is a first aid kit that includes sterile dressings, bandages, thermometers, scissors, tweezers, and a first aid manual. The vehicles used to transport residents are in safe operating condition with appropriate insurance information. LPA did not observe any noticeable outdoor hazards in areas accessible to residents, and the building and grounds are free from hazard that could constitute any harm to any resident in care. There is a locked tool shed in the backyard of the facility, which was locked and opened upon request by LPA. The shed contained outdoor maintenance materials for the facility. BEDROOMS: The facility has Five (5) resident bedrooms, both individual bedrooms for one (1) resident and shared bedrooms for two (2) residents. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All resident bedrooms were furnished and contained beds, chairs, bedside tables and lamps. All beds have sheets, pillows, and mattress pads. There is also an ample supply of linens and towels. The bedrooms have storage areas for clean linens, towels, pillows, etc. Each resident’s bedroom has a single bed or beds, nightstand, and lights/nightstand lamps to provide sufficient lighting. Each closet in all the resident rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any resident. The resident bedrooms are big enough for all beds, furniture, and any resident assistive device a resident might need such as a wheelchair or a walker. Each room has sufficient lighting for each resident. All resident bedrooms have sliding doors into the backyard of the facility, but only some are monitored by auditory alarms if the sliding doors are opened to alert the Staff members of the facility. The LPA was informed that there is no resident in care at the facility at risk of elopement. The second story of the facility contains three (3) Staff member bedrooms. RESTROOMS: There are three (2) resident restrooms in the facility, and one (1) Staff member restroom on the second floor. Continued on 809-C The facility restrooms were sanitized and in operating condition while the LPA toured the facility. All restrooms/showers inspected had assistive equipment for residents including grab bars and/or non-skid surfaces. The restrooms were sufficiently stocked with soap, paper towels, and additional supplies; towels and washcloths are not shared. The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per the regulations between 105-120 degrees Fahrenheit. Nightlights are installed in the hallways outside of the resident restrooms. All resident restrooms consist of a sink and toilet, while the resident shower/bathing areas consist of a shower and/or bathing area with grab bars and non-skid surfaces. LPA observed night-lights present in the main hallway. RECORDS: The facility keeps confidential storage of both resident and Staff member records on-site at the facility. Staff member records were reviewed for, but not limited to Health Screening Report/Tuberculosis (TB) Clearance for facility personnel, Personnel Record (employment application), verification of age over 18 years old, education, and experience, approved Certification for the Administrator, verification of first aid training, Criminal Record Statement, Criminal Record Clearance/Exemption, Verification of Staff training, Employee Rights, and Abuse Reporting Requirements. All staff members’ personnel records reviewed by LPA had the appropriate documentation. The administrator of the facility has an Active Residential Care Facility for the Elderly (RCFE) Administrator Certificate with an effective date of 8/15/2023, and an expiration date of 8/15/2025. Resident records were reviewed for, but not limited to Pre-Admission/Placement appraisals, Resident Appraisals, Appraisal Needs and Services Plan (ANS), Physicians’ Report for RCFE, Identification and Emergency Information, Current Admission Agreement with signatures, Personal Rights for Residents, Record of Residents safeguarded cash resources, Record of Resident personal property/valuables, Physician Orders for Life Sustaining Treatment (POLST), Responsible Person or Conservator of Resident, Self-management of medications if applicable, Medication Orders, and Medication Logs. The facility also keeps records of resident dietary restrictions/preferences for meals and certain residents have weight records maintained. All resident records reviewed by the LPA had the appropriate documentation with no missing or incomplete information. MEDICATIONS: The facility maintains a locked centralized storage area for resident medications. Centrally Stored Medications are in a locked storage containment area within an indoor closet area of the facility, which remains locked at all times, inaccessible/locked to residents. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record, The Medication Administration Record, and the record of Controlled Medications. Continued on 809-C LPA audited the medications for residents and noticed no irregularities or issues concerning the dispensing of medications or the logging of medications. The medications in the facility were labeled appropriately with no additional or prohibited markings by the facility. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members will keep up signs that promote good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exit plans with necessary telephone numbers. The facility keeps posted copies of facility documentation such as the RCFE License Certificate, LIC 500 Personnel Report, Documentation of Facility Waivers, Plan of Operation, Emergency Disaster Plan for Residential Care Facilities for the Elderly (RCFE), Facility Infection Control Plan/Mitigation Plan, Certificate of Liability Insurance, Valid Administrator Certificate, and a Facility Sketch. Provider Information Notices are available and able to be presented to Staff, residents, visitors, and accessible to LPA upon request during the inspection process. No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.the state’s words, verbatim · CDSS document, Mar 27, 2024

Allegation investigated: Staff handled resident in a rough manner Staff are unable to communicate due to language barrier

Licensing Program Analyst (LPA) Olson conducted an unannounced complaint visit to issue final findings. LPA Chavez conducted the investigation, reviewed facility documents and conducted interviews with the staff and residents. LPA Chavez interviewed staff and residents on 6/8/23. LPA Olson interviewed residents on 12/5/23. LPA met with Staff and Administrator over the phone and informed them the reason for the visit. On the allegation: Staff handled resident in a rough manner. It was alleged that staff tossed Resident 1 (R1) around and are mean to R1. R1 had a bruise on their right arm from an IV taken out the previous week. It was also reported that staff didn’t seem to care about the residents needs or concerns. On 6/8/23 LPA Chavez went to the facility for the unannounced initial visit and was greeted by Staff 1 (S1) and Resident 2 (R2). LPA Chaves observed S1 tell R2 to “get back and go away.” LPA interviewed R2 at 1:31pm who stated they do not like S1 because they are mean to R2. At 1:45pm LPA observed Resident 3 (R3) stand up and R2 stated “do you want to see who she [LPA] is?” Continued on 9099-C Unsubstantiated S1 went over to residents and R2 stated “ you won’t even let [R3] see who she is, you’re a mean lady. Do you know you’re a mean lady?”. S1 responded, yes I’m a mean lady.” Interview with Administrator and Licensee revealed that R1 had a psychotic breakdown and was admitted to a mental institution on 6/5/23. R1 was bolting out the door and staff tried to get R1 back in the house, and grabbed R1’s arm to get R1 back. Administrator stated that R1 told them Staff 2 (S2) was mean to R1. Administrator explained there was tension between them because R1 wanted their medication earlier then prescribed and S2 wouldn’t give them to R1. R1 was still at the hospital and not available to speak with at the time of the visit. LPA Olson interviewed residents who stated staff do not rough handle them. Based on the information obtained, there was insufficient evidence to prove that staff handled a resident in a rough manner. However, a Case Management visit will be conducted to address the other personal rights violations discovered during the investigation. On the allegation: Staff are unable to communicate due to language barrier. It was alleged that staff could not speak English. LPA Chavez observed S1 spoke broken English but was able to answer questions, but sometimes had to ask the question twice. S1 stated they moved from the Philippines several years ago to be closer to family. LPA Olson interviewed residents who stated they are able to communicate with staff to get their needs met. Based on the information obtained the allegation is deemed Unsubstantiated.. Exit interview conducted, copy of report issued.the state’s words, verbatim · CDSS document, Dec 5, 2023 · control 29-AS-20230531110058

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Olson conducted an unannounced case management visit to issue deficiencies observed while investigating complaint #29-AS-20230531110058. LPA met with Staff and Administrator over the phone and informed them the reason for the visit. During the investigation on 6/8/23 LPA Chavez went to the facility for the unannounced initial visit and was greeted by Staff 1 (S1) and Resident 2 (R2). LPA Chavez observed S1 tell R2 to “get back and go away.” LPA interviewed R2 at 1:31pm who stated they do not like S1 because they are mean to R2. At 1:45pm LPA observed Resident 3 (R3) stand up and R2 stated “do you want to see who she [LPA] is?” S1 went over to residents and R2 stated “ you won’t even let [R3] see who she is, you’re a mean lady. Do you know you’re a mean lady?”. S1 responded, yes I’m a mean lady.” Interview with Administrator and Licensee revealed that R1 had a psychotic breakdown and was admitted to a mental institution on 6/5/23. R1 was bolting out the door and staff tried to get R1 back in the house, and grabbed R1’s arm to get R1 back. Administrator stated that R1 told them Staff 2 (S2) was mean to R1. Administrator explained there was tension between them because R1 wanted their medication earlier then prescribed and S2 wouldn’t give them to R1. Additional interviews with residents revealed the main staff member S3 is a great caregiver and had no issues with the, but multiple residents stated Staff 4 (S4) is constantly rude to staff and residents. Based on the observation and interviews, residents were not treated with dignity by staff during verbal interactions and when they grabbed R1’s arm. Exit interview, deficiencies issued on 809-D, report given, appeal rights given.the state’s words, verbatim · CDSS document, Dec 5, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Dec 5, 2023

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff...This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when staff did not speak to residents with dignity, which posed an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 5, 2023

Plan of correction: Administrator agreed to schedule a personal rights training with all staff and submit the scheduled training date to CCL by 12/6/23. Administrator agreed to send training records to CCL by 12/15/23.