Villa Toscana A Memory Care Community

Allegation investigated: Staff did not prevent resident in care from leaving the facility without supervision

On May 21, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the complaint investigation findings. LPA met with the administrator and explained the purpose of today's visit. Regarding to the allegation of – staff did not prevent resident in care from leaving the facility without supervision, there is no additional information forthcoming from the reporting party. However, during the initial reporting, the reporting party stated that resident in question (R1) resides in the memory care unit and on March 20, 2026 and March 28, 2026, R1 left the facility unattended and was found in a restaurant next to the facility and the 2nd time, R1 was found in the parking lot agitated. As part of the investigation, LPA interviewed staff members, conducted observations, and reviewed documents. Substantiated LPA interviewed staff #1 (S1) who stated that on the day of the incident (3/20/2026), S1 was working on the 2nd floor where R1 was residing, and R1 was verbalizing multiple times that he/she wanted to leave the unit. When S1 was in the laundry room that was located on the same floor, S1 heard the alarm went off on one of the delayed egress doors and S1 suspected that it was R1 who left the unit. However, S1 could not leave the floor as S1 was the only caregiver who was assigned on the floor. Therefore, S1 alerted other staff members on the 3rd floor who came to assist and subsequently, R1 was found at the restaurant next to the facility. According to the administrator, R1 was moved to the 3rd floor after the incident for additional supervision as there were more staff members assigned to the 3rd floor. Based on the facility’s March staffing schedule, it indicated that S1 was the only caregiver who was assigned to the 2nd floor on 3/20/2026 for 11 residents. During the visit on 4/7/2026, LPA and the administrator tested one of the delayed egress doors on the 3rd floor, the alarm went off immediately, but no staff responded. The door opened after 30 seconds, the administrator exited the floor and 2 staff members walked toward the door after 60 seconds. The administrator acknowledged that staff members should have responded to the alarm before the door opened. Regarding the second incident on 3/28/2026, LPA attempted to obtain more information from the administrator, the director and facility staff members but no one remember this incident and there was no documentation of such incident. During the investigation, the administrator acknowledged that she attempted to report this incident via electronically to CCL but it was never sent. This observation will be cited under Case Manager on LIC 809 and 809D. After the investigation, this allegation is substantiated as there was insufficient staffing for one caregiver to care for 11 residents resulting in R1 leaving the floor unattended through the delayed egress door and S1 could not follow R1 as S1 had to stay on the floor to care for the other residents. This report is reviewed and discussed with the administrator. A copy is provided with the appeal rights.the state’s words, verbatim · CDSS document, May 21, 2026 · control 26-AS-20260330133147

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: May 22, 2026

87468.2 Additional Personal Rights of Residents..(a) In addition to the rights..4) To care, supervision,. their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by R1 resides in a memory care unit and on 3/20/2026, R1 left the unit unattended and S1 was not able to follow R1 as S1 was the only caregiver who was working on the floor so S1 had to stay to care for the other residents. in addition, staff did not respond to the delayed egress door in a timely fashion which posed an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, May 21, 2026

Plan of correction: The administrator will develop a plan of correction indicating what action(s) that the facility will implement to ensure there are sufficient staff to delivery the needs and supervision of the residents. In addition what is the action that the facility will take to ensure staff members are competent with the protocols when the delayed egress door alarms goes off. The plan of correction shall include staff education. The administrator will provide a copy of the plan of correction to CCL by 5/22/2026.

Type of visit: Case Management - Deficiencies

On May 21, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management visit to deliver a finding that was observed during the complaint investigation. LPA met with the administrator and explained the purpose of today's visit. During the investigation of complaint # 26-AS-20260330133147, it was observed that facility did not report to CCL of an incident that happened on March 20, 2026 concerning a resident (R1) who left the facility unattended. The administrator acknowledged that it was not reported to CCL in a timely fashion. Based on observation interview and record review, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with the administrator. A copy of the report and appeals rights are provided.the state’s words, verbatim · CDSS document, May 21, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1) · Plan of correction due date: May 22, 2026

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require,..(1) A written report shall be submitted to the licensing agency.. within seven days of the occurrence of any of the events This requirement is not met as evidenced by the facility did not report to CCL that R1 left the facility unattended which poses an immediate health and safety risks to residents in care,the state’s words, verbatim · CDSS document, May 21, 2026

Plan of correction: The administrator will develop a plan of correction to ensure compliance and will provide a copy of the plan of correction to CCL by 5/22/2026.

Type of visit: Required - 1 Year

On May 21, 2026, Licensing Program Analyst (LPA) Murial Han conducted an annual inspection. LPA met with administrator, Mamta "MJ" Jain and LPA explained the purpose of today's visit. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a 3-floor facility; 1st floor being the entrance to the lobby, 2nd and 3rd floors are Memory Care Units. LPA inspected activity area, dining room and other commons areas and observed some residents participating in the activity and some watching TV. All common areas were free from obstructions and in good operating condition. Hot water temperature throughout the facility was measured at 124- 136 degrees F. During the tour, LPA observed staff members conducting varies activities and engaging residents. A comfortable temperature is maintained, and lighting is sufficient for comfort. Medication cart on the 3rd floor, medication in room 204 and chemicals were unlocked and accessible to residents in care. 2 days of perishables and 7 days of nonperishable foods were observed for the residents. Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguishers were last serviced on 6/18/2025. Emergency and fire drill records were observed to be sufficient. A review of (5) resident files was conducted and noted on LIC 858. A review of (6) staff files was conducted and noted on LIC 859. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. . This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, May 21, 2026

Allegation investigated: Resident’s call light is in disrepair.

On February 24, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced 10-day complaint visit. LPA met with Care Coordinator, Blanca Evia Del Puerto and explained the purpose of the visit. Regarding the allegation, resident's call light is in disrepair, according to the reporting party, on 2/9/26, during a facility visit, it was observed that a red cord was tied to extend the existing red cord in Resident 1's (R1's) room and when the reporting party pulled the cord, staff did not come. According to the reporting party, he/she was notified that it was an IT problem. As of 2/17/26, it was observed that R1's call light has not been resolved. During the investigation, LPA tested R1's call light, interviewed staff, and reviewed documentation. Based on observations, LPA observed R1's call light to be in good working condition. According to staff interviewed and documentation reviewed, after this issue was brought up to management, the facility immediately contacted their IT team to troubleshoot the system. (Continue to 9099C). Unsubstantiated In addition, according to staff interviewed and documentation reviewed, the whole call light system was down for about two weeks, however the facility immediately started taking steps to fix this issue as soon as it was brought up. Staff indicated that while the call lights were in disrepair, staff increased resident checks to every 30 minutes to an hour or as needed based on resident needs. Based on documents reviewed, information collected, and interviews conducted, the department has determined that although the above allegation may have happened or are valid, there is no a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation is UNSUBSTANTIATED. Report is reviewed with Care Coordinator, Blanca Evia Del Puerto and a copy is provided.the state’s words, verbatim · CDSS document, Feb 24, 2026 · control 26-AS-20260218092744

Allegation investigated: Facility staff do not ensure infection control guidelines are being followed Facility staff do not ensure food is of good quality for residents in care Staff neglect residents. Staff are forcing residents to participate in activities

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator MJ Jain. On 06/14/2024, the department received a complaint with the above allegations. On 06/20/2024, LPA Marrufo conducted an initial complaint investigation visit. On 09/12/2024 and 11/19/2025, LPA Marrufo conducted additional complaint investigation visits. Allegation: Facility staff do not ensure infection control guidelines are being followed When the department received the complaint, it was alleged that the facility did not have available COVID testing kits and that staff were not wearing Personal Protective Equipment (PPEs) when entering the living units of COVID-positive residents while they were being isolated. It was alleged that staff S1 became COVID-positive after entering one of the COVID-positive resident’s living unit without PPEs. See LIC9099-C pages for more information. Page 1 of 4. Unsubstantiated The Community Care Licensing Department (CCLD) Infection Control Practices References Guide for RCFE states on page 9: “Facilities with COVID-19 cases retest all staff and residents in accordance with Community Care Licensing guidance, until no new cases are identified in two sequential rounds of testing.” On 06/10/2024, the facility submitted an Incident Report stating that on 06/07/2024, resident R1 was found to have an elevated temperature and was transported to the hospital. At the hospital, R1 tested positive for COVID. R1 was returned to the facility on 06/08/2024. During interview on 09/12/2024, LPA Marrufo interviewed Administrator (ADM) Engracia “Grace” Sandoval. ADM stated that after R1 returned to the facility, R1 was isolated in his/her living unit. R2 was the only other resident at the facility at the time. ADM stated that R2 did not need to be isolated since R2 was the only other resident in the facility besides R1 and R1 was being isolated in his/her living unit. ADM stated that the facility did not have COVID tests available when R1 was tested positive with COVID. ADM stated to have ordered more COVID tests and requested COVID tests from other facilities operated by the licensee. ADM stated staff S2 brought a COVID test from S1’s home and used it to test R2. ADM stated R2 took the COVID test and tested positive. ADM stated to have not sent an Unusual Incident/Injury Report for R2’s positive COVID case. During interview on 09/12/2024, S1 stated to have not gotten COVID while working at the facility. S1 stated to have either had a cold or allergies. S1 stated to have had symptoms of coughing and a runny nose. S1 stated to have taken a COVID test at home, and it had a negative test result. S1 stated to have worn gloves and a mask while coughing and having runny nose symptoms. On 12/10/2025, LPA Marrufo obtained a copy of a police report from local law enforcement. The police report stated that a police officer visited the facility on 06/14/2025. During the visit, the police officer conducted a welfare check on R1 and R2. The police officer observed appropriate protective personal equipment for COVID-19 outside of the apartments of R1 and R2. On 12/24/2025, LPA Marrufo reviewed the facility file and did not find an LIC808 COVID-19 Mitigation Plan Report. Page 2 of 4. Allegation: Facility staff do not ensure food is of good quality for residents in care When the department received the complaint, it was alleged that the food is of poor quality and the meat is tough and difficult for the residents to swallow. During visit on 06/20/2024, LPA observed lunch being served to residents R1 and R2. LPA observed a staff cut R1’s chicken into small pieces. LPA observed R2 was served chicken and was given a fork and butter knife. LPA observed R2 cutting the chicken with the fork and by using R2’s fingers. LPA observed that R1 had a staff sitting nearby assisting R1 with eating. LPA did not interview R1 out of concern of causing a choking incident while R1 was eating. During visit on 09/12/2024, LPA Marrufo approached R1 and asked R1 for an interview, and R1 verbally refused to be interviewed. LPA interviewed R2 while R2 was eating lunch. R2 stated R2 can cut the chicken and the chicken tasted fine. R2 stated the food at the facility tastes fair. R2 stated R2 can cut the food and the food is not too tough. R2 stated that R2 can swallow the food. During interview on 06/20/2024, ADM stated that food can be pre-cut for residents and sauces are added to make sure the food is not too dry. ADM stated food is cooked tender enough for residents and the facility has the equipment to ensure the food is tender. Allegation: Staff neglect residents. When the department received the complaint, it was alleged that R2 asked S2 for assistance and S2 stated S2 needed to get coffee first. R2 stated during interview to have never asked for help and not received help from staff. R2 stated to not recall any time when R2 asked a staff for help and the staff stated to need to get coffee first before helping R2. Page 3 of 4. During interview on 06/20/2024, staff S2 stated to have approached R2 while R2 was having breakfast and asked R2 how R2 was doing. S1 stated to have told R2 that S2 cannot function without getting coffee first, but R1 was not asking for help from S2. Allegation: Staff are forcing residents to participate in activities. When the department received the complaint, it was alleged that staff S2 has forced R1 and R2 to participate in activities. During interview on 06/20/2024, S2 stated to have never forced R1 or R2 to participate in activities. During interview on 06/20/2025, R2 stated to have never been forced to participate in activities. During visit on 09/12/2024, LPA Marrufo attempted to interview R1, but R1 refused to be interviewed. Based on information from interviews conducted with staff and residents, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22 This report was reviewed with Administrator MJ Jain and a copy of this report was provided. Page 4 of 4. END REPORTthe state’s words, verbatim · CDSS document, Dec 30, 2025 · control 26-AS-20240614094332

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Dec 31, 2025

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: During visit on 06/20/2024, LPA Marrufo observed a container of Clorox cleaning wipes in an unsecured cabinet in the dining area, which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: Licensee agrees to submit a plan of correction by 12/31/2025 stating how staff will receive in-service training on ensuring disenfectants, cleaning solutions, and other similar items which could pose a danger to residents are locked in storage. Once training is completed, the Licensee agrees to submit training records that include names of staff trained, training dates, training topic, and names and qualifications of trainers.

Type of visit: Required - 1 Year

On May 13, 2025, at 09:00 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Executive Director (ED) Andrew Pence. The ED informed the LPA that the facility currently has 19 residents in care. At 9:35 AM, the LPA initiated a walk-through of the facility along with the ED. LPA inspected six (6) random resident rooms on the third floor, and found them clean, well-lit, and equipped with the required furniture. Emergency pull cords were observed to be functioning in the resident rooms with an average response time of 5 minutes. LPA inspected the private bathrooms in these random rooms. The bathrooms contained soap, grab bars, towels, a trash can, and non-slip flooring. The hot water temperature at the sink faucets measured between 116.5°F and 119.8°F. LPA inspected the dining room and found it clean, with all the furniture in good repair. Residents were observed eating snacks in the dining room. Cleaning supplies, chemicals, and sharp objects were observed inaccessible to the residents. LPA inspected activity area and other commons areas and observed some residents participating in the activity and some watching TV. All common areas were free from obstructions and hallways were well-lit. LPA toured the patio area and found passageways in good condition, free of obstructions, and without any blocking or tripping hazards. These areas had patio tables, chairs, and umbrellas for residents’ use. Delayed egress was observed on emergency exits and patio doors were locked. No accessible bodies of water or hazards were observed. Continued on LIC 809-C LPA inspected laundry room on the second floor with washer and dryers. The laundry room was inaccessible to the residents in care. LPA inspected the main kitchen on the first floor and found it clean. The refrigerator, freezer, and pantry were checked, and there was a sufficient supply of fresh perishable food for two (2) days and nonperishable staples for seven (7) days. No expired food items were found. Open food items were wrapped and dated. LPA inspected the fire extinguishers mounted in the kitchen and found they were fully charged with a last service tag of 02/27/2025. The ED tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. LPA reviewed the Fire Prevention routine inspection report, conducted on February 06, 2025, by the Department of Fire and Environmental Protection division, City of Mountain View. LPA inspected the medication room on the second floor. Medications were organized in separate bins for each resident. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records (CSMR) were reviewed and found to be complete. LPA observed and inspected narcotics medications inside a locked centrally stored medication cart located in the dining room. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 03/20/2025. LPA reviewed five (5) random resident files and five (5) random staff personnel records. The LPA observed that 5 of 5 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan. LPA observed that 5 of 5 staff members had First Aid/CPR training, LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 5 of 5 staff members are associated with the facility. The following updated forms are requested to be submitted to CCLD by 05/19/2025: 1) LIC 500: Personnel Report 2) LIC 308: Designation of Facility Responsibility 3) Certificate of Liability Insurance 4) Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Executive Director. A copy of this report was left with the Executive Director, Andrew Pence, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, May 13, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) David Marrufo conducted a Prelicensing visit and met with Grace Sandoval, Executive Director. During visit, LPA Marrufo toured the inside and outside of the facility. LPA Marrufo toured the kitchen area and observed the refrigerators and storage areas for food and supplies. LPA toured the facility exterior and observed the exits to be clear of obstructions. LPA observed the second and third floors of the facility and observed the medication rooms, activity rooms, and resident living areas. During visit, LPA Marrufo reviewed the Component III presentation with Grace Sandoval, Executive Director. Pre-Licensing is complete and this facility has no deficiencies. This report was reviewed with Executive Director Grace Sandoval and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 2, 2024