Villa-Care Home IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melisa Rankin arrived at 8:30 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. 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 5 non-ambulatory residents and 1 bedridden resident. The facility currently has 5 non-ambulatory resident and 1 ambulatory. Staffing, Personnel Records & Training: The facility currently employs 4 staff, on-call staff and has 2 administrators who also provide care giving coverage. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Continued on 809-C 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. 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 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 on 1/1/26. 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 working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Jan 14, 2026

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Uncleared person present at facility

On 05/07/2025 at 7:50 a.m. Licensing Program Analyst’s (LPA) Rankin and Jeffries conducted a 10-day complaint visit to the facility above. LPAs met with Jennifer Villaros, Administrator and explained the purpose of the visit. During the investigation, LPA Rankin and Jeffries observed the facility, interviewed administrator and staff, and interviewed all residents and collected relevant documentation. Unsubstantiated On the allegation: Uncleared person present at facility. It was alleged that an exclude person had resided at the facility. It was discovered through observations, interviews, and documentation, that on 05/07/2025, Licensing Program Analyst (LPA’s) Rankin and Jeffries observed one care giver (S1) and 4 residents. (R1, R2, R3, and R4). On 05/072025 LPA Rankin conducted resident interviews for R1 and R2, who both stated that the care was good, and both stated they had no knowledge of the exclude individual(s) presence at the facility. On 05/07/2025, LPA Jeffries conducted interviews with R3. R3 interview was inconclusive on exclude individuals being present at the facility but feels safe and comfortable in the facility. On 05/07/2025 LPA Rankin interview Care Staff (S1) and Administrator. S1 stated they work morning shifts and are not aware of the excluded individuals present at the facility. On 5/7/2025 LPA Rankin interviewed administrator who stated she was aware that excluded individuals are not to be at the facility. Documents collected were staff and resident rosters. The excluded individuals were not noted on either documents. All rooms occupied were of residents noted on the roster and there are no staff rooms at this facility. Based on interviews, observation and documentation, there is not sufficient evidence, at this time, to prove the alleged violations did or did not occur therefore the allegations are unsubstantiated. Exit interview conducted, copy of report given.the state’s words, verbatim · CDSS document, May 7, 2025 · control 29-AS-20250501143031

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erika Miller arrived at 10:35 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: Infection Control: The facility has a current Infection Control Plan. The facility has a supply of PPE and have additional PPE stored at their other facilities, which are readily available.Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: LPA was authorized to enter and inspect facility. 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. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have slip resistant mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant 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 resident use. The fire extinguisher was last charged and inspected on 12/11/24. The facility has smoke and carbon monoxide detectors that were tested and working properly. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill/training on 10/1/24. 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 working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Dec 19, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jenny Olson arrived at the facility unannounced to conduct a required annual visit at 10:40 a.m. When LPA arrived, there was one staff and four residents present. LPA was later greeted by Administrator and Licensee and informed them of the reason for the visit. LPA 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. KITCHEN: Knives are stored in a locked drawer in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Common areas: Living and dining room furniture were observed to be in good condition. At 11:45 a.m., carbon monoxide detector were tested and operational at the time of the visit. There is a fireplace in the living room, which is screened and inaccessible. LPA observed required postings throughout the common space. The fire extinguisher was charged and serviced 1/25/2024. The backyard is equipped with furniture for client use. No bodies of water noted. The washer and dryer are in the laundry room. Restrooms: The two resident restrooms were clean and sanitary and in operating condition with non-skid mats. The bathrooms were sufficiently stocked with soap and paper towels. Bedrooms: There are four (4) resident rooms, which were furnished. A linen closet was located outside of the rooms, which stocked extra linens and towels. Records: LPA reviewed resident and staff records from 10:40- 11:40 a.m. LPA reviewed four (4) resident files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, and current needs and services plan. One residents was missing their TB test. Administrator stated they will obtain the TB test results from their PCP. Continued on 809-C LPA reviewed three (3) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid certification. All were complete. MEDICATIONS: Medications review began at 2:15 p.m. The medications are centrally stored and locked in a cabinet in the dining room. Medications are labeled and checked for expiration dates. All the necessary information is properly documented on the CSMAR! INFECTION CONTROL: 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. 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. At 2:50 p.m., LPA interviewed one (2) staff members and two (2) residents. During today’s visit, the LPA obtained copies of the following: staff roster and current liability insurance. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 26, 2024

The state marks this report as 7 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.