Villa Regina III

Type of visit: Required - 1 Year

On November 17, 2025, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrators (ADs) Mark Fisk and Erin Fisk were notified via telephone and later arrived to assist with the inspection. LPA observed that Mark Fisk and Erin Fisk have valid Administrator certificates expiring on January 27, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for four. The facility is a single story home with six bedrooms, four private resident bedrooms, one shared resident bedroom, one staff bedroom, and two bathrooms, a living room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by the AD, conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care and two care giving staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the hallway. LPA inspected the five resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in the hallway closet. LPA inspected both bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 118.4 and 118.7 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. Continued on LIC-809 C. LPA observed the four burner electric stove is functional. LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed a fire extinguisher mounted in the kitchen and it was observed to be charged and purchased on September 24, 2025. LPA tested the wired smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on October 1, 2025. The centrally stored medication is kept in a locked cabinet in the kitchen. The First Aid kit is stored in the laundry room and it was observed to have all the required components. Chemicals and cleaning supplies were observed to be locked in the laundry room. LPA observed the facility has a three day emergency food and water supply stored in the laundry room. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. The garage is used for storage. LPA and AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate is self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed five resident files. LPA reviewed five out of five residents’ medication and medication records. LPA reviewed two staff files. All staff are background cleared and associated to the facility. Based on today's observations, there are no deficiencies being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Erin Fisk and a copy of the report was provided and reviewed.the state’s words, verbatim · CDSS document, Nov 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by care staff and LPA explained the nature of the visit. Mark Fisk, Administrator and met with LPA. There are five residents at the facility and there are two residents receiving hospice services currently. LPA began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in dining room. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the bathroom, and LPA measured the hot water temperature which measured 112.6 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in the laundry room. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor Continued on LIC809-C passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment. LPA observed a fire extinguisher with service date of October 01, 2024 and LPA reviewed fire drill logs. LPA began review of records. LPA reviewed three resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed two employee records.All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 12, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Jessica Cho and Rose Ruppert conducted an unannounced Required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPAs met with Caregiver Aurea Mihardjo and explained the purpose of the visit. The facility is licensed to operate for six non-ambulatory and maintains a hospice waiver for four. The facility is a single-story structure located in a residential neighborhood which consists of the following: five resident bedrooms, one staff bedroom, two bathrooms, living room, family room, dining area, kitchen, laundry room, outdoor patio area, and a two car garage which is being utilized as a storage and did not have a clear passageway to walk inside. LPAs observed clutter which includes but is not limited to: refrigerator, wooden panels, dresser, extra mattresses, boat, and additional items. LPAs toured the interior and exterior of the facility with Administrator Mark Fisk who arrived at 12:45pm. Administrator Brigitte Fisk also arrived shortly. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each client’s personal belongings were observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 118.4 degrees Fahrenheit in both bathrooms. A comfortable indoor temperature of 72 degrees Fahrenheit was maintained in the facility. LPAs observed the facility to be sanitary and appropriately furnished at the time of visit. Sharps and toxins were stored and inaccessible to the residents. Three cleaning solutions were unsecured in the resident's closet, however due to all the residents being non-ambulatory, licensee was reminded of the regulations and the items were secured during the visit. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. The facility has one fire extinguisher that was charged and serviced on October 4, 2023 and another in the garage. Smoke/carbon monoxide detectors were tested and operational. The facility did not conduct emergency drills and did not maintain a record. A working telephone (949-998-9191) remains available. The First Aid Kit contained all the necessary elements. During the visit, LPAs observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPAs observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The 'See Something Say Something" (PUB475) was maintained in the correct size that exceeded 20"x26." LPAs conducted an audit of six residents' files and two personnel files. LPAs conducted two staff and three resident interviews. Interviews with three remaining residents were not conducted due to residents sleeping. Medications were audited for two out of the six residents. Discrepancies were noted for one out of the six residents. The following were advised: clear the clutter in the garage, to ensure CCL is informed about the alterations made to the facility, audit medications to ensure the medications provided are current on the medication list, obtain a current Physician's Report for four out of the six residents, obtain a doctor's order for half bed rails for two residents, conduct emergency drills of various scenarios quarterly and maintain a record, and ensure the cleaning solutions are inaccessible at all times.. Deficiencies are being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. Advisory Notes are also being issued, and an immediate civil penalty is being assessed. See LIC421IM. The remaining deficiencies and Advisory Note(s) will be addressed on the continuation annual inspection at a later date due to time constraints. An exit interview was conducted with Administrators Brigitte Fisk, Mark Fisk, and Erin Fisk, however the reports were not signed by the administrator, and a copy of this report including the LIC9099-C, LIC9099-D, and the LIC421IM, and the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, May 9, 2024