Villa Theresa 2 Care Home

Type of visit: Required - 1 Year

**LPA had a hardware issue, This is copied over from the handwritten verision left with the administrator, LPA is going back there before the end of september to collect a signature and finish the visit.** on 9/4/25, at 9:15, Licensing Program Analyst(LPA) Noel Wolf Petersen arrived unannounced to conduct an annual inspection at Villa Teresa Care Home II, and met with Alan "JJ" Jose to conduct an annual investigation. Plant is licensed for 6 nonAmbulatory adults over 60, One resident has injectable diabetic medication, one resident is on hospice with oxygen administration. 4 residents have dementia. Physical inspection, some rust on the evacuation gate, food needs to be higher count (nonperishable / emergency), it is low for 4. A review of client records, indicated 1 resident has impulsivity diagnosis, and a limited access to personal hygine items. Review of staff records indicates presient first aid, backround clearance, but not training relevant to diabeties care or dementia. Training for the facility is updated to include diabetic, dementia, and oxygen administration care. Physical plant Inspection included but not limited to the client bedrooms, bathrooms, common areas, kitchen, exteriors, and evacuation routes. Personal hygiene toxics were left out, this is a mixed population of dementia and non dementia, with ambulatory and wandering/impulsively type diagnoses. Member with the behaviors is also on hospice and not physically able to endanger themselves so only a technical violation. LPA asked the facility to lock the personal hygine items. No Citations given, Exit interview conducted, a copy of the report was read and given to staff.the state’s words, verbatim · CDSS document, Sep 4, 2025

Type of visit: Case Management - Other

On 10/01/24, LPA Campbell arrived to the facility unannounced. LPA Campbell met with Sharon Fernandez, House Manager and stated the purpose of the visit. LPA Campbell conducted a case management to obtain a signature for an annual deficiency conducted on 09/26/24. LPA Campbell conducted a tour of the facility Staff confirmed that debris had been removed from the backyard as discussed during the annual inspection. No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes. A hard copy of this report and updated deficiency page have been left with the House Manager, Sharon Fernandez.the state’s words, verbatim · CDSS document, Oct 1, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Renee Campbell arrived at the facility to conduct an unannounced annual inspection on 09/26/2024. LPA Campbell met with Sharon Fernandez, House Manager and Administrator and explained the purpose of the visit. LPA Campbell inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and the backyard of the facility to ensure compliance with Title 22 regulations. This facility is a single story building licensed to serve six (6) ambulatory residents and there is a hospice waiver for three (3). LPA Campbell observed the facility to be free of odor, clean and in good repair. LPA Campbell observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Campbell observed sufficient seven-day non-perishable and two-day perishable food supplies. The hot water temperature was measured in the kitchen and bathroom. The kitchen water temperature measured at 109.6 degrees and the resident bathroom water temperature measured at 109.4 degrees. Fire extinguishers, smoke and carbon monoxide detectors are in good repair. The fire extinguisher was last inspected on 07/25/2024. The facility thermostat was observed at 73 degrees Fahrenheit. LPAs checked medication storage and found medication to be locked away and inaccessible to clients in a kitchen pantry. The First aid kit was incomplete and was missing a tweezer that was provided during the visit. LPA Campbell requested client and staff files for review. LPA Campbell reviewed 4 of 4 resident files and 4 of 10 staff files. Of the 4 files reviewed, 2 of them were missing Personal Rights documentation. Staff files were complete. Toxins were made inaccessible to clients in care. Toxins were stored in a locked cabinet in the laundry room. The following documents will be email to LPA Campbell (Renee.Campbell@dss.ca.gov) by 09/30/2024 by 5:00 PM by end of day: (1) LIC 308 Designation of Administrative Responsibility (2) LIC 500 Personnel Report (3) Copy of Administrator Certificate (once the new one is received by Administrator) (4) LIC 610 Emergency Disaster Plan (5) LIC 9282 Infection Control Plan Per California Code of Regulations, Based on today's inspection, per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed or cited and noted on LIC 809D. Note that failure to correct any deficiencies will result in additional civil penalties. An exit interview was conducted and a copy of this report was left with the facility.the state’s words, verbatim · CDSS document, Sep 26, 2024