Villa Verde

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Licensee/Administrator, Dominica Oliva and Joseph Oliva and stated the purpose of today's visit. LPA Rai observed 3 staff and 6 residents at the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai observed 1 shed in the backyard used for storage space and not habitual space. LPA Rai toured the facility to include 5 resident rooms, 2 staff room, living room, dining room, kitchen and garage. 5 Out of 5 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom and kitchen sink ranged from 110.3 - 110.4 degrees F. Fire extinguisher was observed and inspected on 05/15/2026. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drill was conducted in November 2025 and Licensee does not have record of disaster drill conducted in 2026. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed at random 2 resident medications and central stored medication records. Resident R1 has 5 medications which are centrally stored. 2 Out of 5 centrally stored medications were not logged on the Centrally Stored Medication Log and 2 out of 5 centrally stored medications did not have the start date written on the Centrally Stored Medication Log. Resident R2 has 4 medications which are centrally stored. 1 Out of 4 centrally stored medication was not logged on the log which poses/posed a potential health, safety or personal rights risk to persons in care. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. This report was reviewed with Licensee/Administrator, Dominica Oliva and Joseph Oliva and a copy of the report was provided. LIC 858 and LIC 859 were provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Aug 5, 2026

Type of visit: Required - 1 Year

On 8/27/2025, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Care Staff Nool and explained the purpose of the visit. LPA toured the inside and outside of the facility. Residents are currently having lunch. When touring the outside area of the facility, the exits were cleared of obstruction. Facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of non-perishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. Resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sink was tested at 118 degF. Fire extinguisher was observed and inspected. Facility smoke detectors and carbon monoxide detectors were in working condition. Five resident records and three staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic 20hr requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No deficiencies are cited at this time. Report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Aug 27, 2025

Allegation investigated: Staff confronted and yelled at a resident. Facility staff argued disregarding resident's personal rights.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Licensee, Dominica Olivia and stated the purpose of today’s visit. On 2/27/2023, the Department received a complaint with the above allegations. On 3/9/2023, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 2. Unsubstantiated Page 2 of 2. Staff confronted and yelled at a resident. /Facility staff argued disregarding resident’s personal rights. It was alleged on 2/18/2023, resident R1 informed staff S2 about staff S1 yelling at R1 and stating, “caregivers at the home does not like to take care of you”. Staff S2 reassured R1 that the statement was not true. S1 confronted S2 in front of R1 stating R1 was lying and both staff were yelling at each other. On 3/9/2023, the Department interviewed 3 staff. Three out of three staff stated the staff do not yell at the residents or yelling in front of the residents. S1 stated he/she has a deep voice and people misinterpret his/her voice as “yelling”. S1 stated R1 misunderstood the statement made on 2/18/2023 and want to explain to R1 that R1 is delicate, and they want to ensure the facility staff do not hurt R1. On 3/9/2023, the Department interviewed 3 residents. Two out of three residents stated staff do not yell at residents. R1 stated staff S1 yells and raises the voice towards R1 but S1 is better now. R2 and R3 stated they have heard staff argue with each other but cannot recall the staff names and when it had occurred. On 3/9/2023, the Department interviewed 1 visitor (V1) at the facility. V1 stated he/she comes to the facility 3 times a week and has not observed or heard staff yelling or arguing with the residents or staff. Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Licensee, Dominica Olivia and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 28, 2024 · control 26-AS-20230227150412

Allegation investigated: Facility did not provide adequate care for resident’s wound.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Licensee, Dominica Olivia and stated the purpose of today’s visit. On 6/23/2023, the Department received a complaint with the above allegations. On 6/28/2023, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 2. Unfounded Page 2 of 2. It was alleged that the facility did not provide adequate care for the resident R1’s wound on right foot which resulted wound being infected by maggots. On 10/28/2022. The Department received Incident Report for R1 wherein R1 was sent to the hospital due to ADM noticed an unusual smell and observed wound on right foot. Based on review of R1’s Appraisal/Needs and Services Plan dated 7/3/2021, R1 takes walks regularly and R1 is able to do functions of daily living. R1 needs assistance in housekeeping and medication. Based review of R1’s Physician’s Report dated 6/23/2021, R1 is has a mental health diagnosis and R1 able to leave the facility unassisted. R1 is not able to administer own prescription medications and not able to store own medication. On 9/28/2024, LPA Rai interviewed 1 staff (S1) who is aware of incident regarding R1. S1 stated the facility staff only assisted R1 with medication and housekeeping as R1 was independent with all other Activities of Daily Living (ADLs). R1 was able to grooming, bath/shower and dress himself/herself. S1 stated the staff did not observe R1 had wounds before this incident and R1 did not have any home health services for wound care. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Licensee, Dominica Olivia and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 28, 2024 · control 26-AS-20230623154414

Allegation investigated: Staff is verbally humiliated and verbally abused the resident.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Licensee, Dominica Olivia and stated the purpose of today’s visit. On 7/5/2023, the Department received a complaint with the above allegations. On 7/13/2023, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 2. Unsubstantiated Page 2 of 2. On 7/13/2023, the Department interviewed 3 staff (S1-S3). Three out of the three staff stated they did not observe or hear a staff member verbally humiliate or verbally abuse a resident. S1 stated there is a staff member that speaks loudly but cannot recall when staff have humiliating or verbally abusing the residents. On 7/13/2023, the Department interviewed 2 residents (R1-R2). One resident declined to answer LPA’s questions regarding the allegation. R2 stated staff have not been rude or loud to the residents and cannot recall an incident where staff have humiliating or verbally abusing the residents. On 7/12/2024, the Department interviewed 1 witness (W1). W1 stated staff would assist residents but cannot recall a time where staff were humiliating or verbally abusing residents. W1 has not seen or heard any staff verbally humiliating or verbally abused the resident. Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Licensee, Dominica Olivia and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 28, 2024 · control 26-AS-20230705151829

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Licensee, Dominica Oliva and stated the purpose of today's visit. LPA Rai observed 3 staff and 3 residents at the facility and 2 residents were out of the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the resident bedrooms. 6 Out of 6 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sinks ranged from 117.7 - 119.7 degrees F. Fire extinguisher was observed and inspected on 04/29/2024. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 08/05/2024 and 05/04/2024. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records. No deficiencies were cited per California Code of Regulations, Title 22. Technical Violation was provided. This report was reviewed with Licensee, Dominica Oliva and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2024

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff retained a resident with a prohibited health condition

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Licensee, Dominica Olivia and stated the purpose of today's visit. On 8/15/2023, the Department received a complaint with the above allegation. On 8/16/2023, the Department conducted an initial investigation at the facility. On 5/18/2023, R1 was assessed with a stage 2 pressure injury on the coccyx area. R1 received wound care by home health nurse. The facility staff requested R1's responsible party for additional home health visits, wound care supplies and a referral to O'Conner Hospital wound care clinic. From 5/18/2023 to 5/26/2023, the facility staff repositioned R1 every two hours. Based on review of R1's progress notes, R1's pressure injury changed in condition. On 5/26/2023, R1 went to a doctor's appointment and was admitted to the ER afterwards. The hospital doctor diagnosed the wound as a stage 4 pressure injury. Continuation on LIC 9099-C, Page 1 of 2. Substantiated Page 2 of 2. Based on interview with family member (FM1), staff S2 called FM1 on 5/18/2024 at approximately 9:00am to inform them about noticing blood during R1's incontinence care. Based on an interview with family member (FM2), staff S2 called FM1 on 5/18/2023 at 9:18am to request home health nurse to observe the wound, referring to the blister. On 8/16/2023, the Department interviewed Licensee (LIC), who stated staff S1 called LIC at approximately 5:30am regarding R1's blister/wound and S1 informed S2 during shift change. LIC stated at approximately 8:00am, R1's responsible party was informed. LIC stated from 5/18/2023 - 5/26/2023 she was communicating with R1's responsible party via phone call to schedule an appointment with R1's primary care physician and request for home health nurse to visit R1 at the facility. On 8/16/2023, the Department interviewed 3 staff (S1-S3), 3 out of 3 staff stated the facility staff informed R1's responsible party regarding R1's blister/wound the morning of 5/18/2023 via telephone call and requested a visit from the home health nurse. The Department has completed the investigation of the above allegation. Based on interviews conducted and record review, the Department has found that the above allegation were UNFOUNDED, meaning the allegations were false, could not have happened and/or without a reasonable basis. No deficiencies were cited from California Code of Regulations, Title 22 during today's visit. This report was reviewed with the Licensee, Dominica Olivia and a copy of the report was provided. Page 2 of 2. Based on interview with family member (FM1), R1 was taken to the hospital on 5/26/2024 after an appointment with R1's primary care doctor. O'Conner Hospital assessed R1's wound on coccyx as a stage 4 pressure injury. Based on interview with family member (FM2), on 5/18/2024, home health nurse visit R1 at the facility and the wound near the tailbone was measured as a stage 2 wound. On 5/22/2023, FM1 spoke with home health nurse and stated R1's wound was stage 2 and the wound would continue to be treated with Tera Honey and bandaged. On 5/23/2023, the condition of the wound changed where the wound was described as "yellow with pus discharge". On 5/24/2023, the home health Physical Therapist (PT) observed the wound was growing bigger and now was a "deep hole with oozing pus". On 5/26/2023, FM1 transported R1 to R1's doctor's appointment where R1's primary care physician advised R1 to be taken to the Emergency Room immediately. On 5/27/2024, after R1 was diagnosed with stage 4 pressure injury, R1 underwent surgery for the wound. Based on review of R1's progress notes, On 5/23/2023, staff noticed R1's wound changed condition and on 5/26/2023, R1 received medication attention and wound was assessed as a stage 4 pressure injury. On 11/16/2023, the Department conducted an interview with the Licensee (LIC). LIC stated the facility can only keep a resident with a stage 2 wound and if the wound worsens to anything above a stage 2, the resident will need to be transported to the hospital for an evaluation. LIC stated R1 was not under Hospice services. The Department has completed the investigation of the above allegation. Based on interviews and record review, the preponderance of evidence standard as been met therefore the above allegation is found to be SUBSTANTIATED. Deficiencies were cited from California Code of Regulations, Title 22 during today's visit, see LIC 9099-D. This report was reviewed with Licensee, Dominica Olivia and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Jul 11, 2024 · control 26-AS-20230815094915

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Jul 18, 2024

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly(1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on record review and interview, R1 was residing at the facility from 5/23 -5/26/2023 with a change of condition of the stage 2 pressure injury and became a stage 4 pressure injury which poses/posed an immediate Health, Safety, or Personal..the state’s words, verbatim · CDSS document, Jul 11, 2024

Plan of correction: Licensee will provide a written plan of action understanding the regulation and ensure residents with wounds are assessed to determine if the wound has developed into stage 3 and stage 4 and appropriate measures are taken. Licensee agreed and understood. (con't) Rights risk to persons in care.

Allegation investigated: Staff did not reposition resident every two hours causing resident's pressure injury to worsen

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Licensee, Dominica Olivia and stated the purpose of the visit. On 8/15/23, the Department received an allegation of neglect and lack of supervision that staff did not reposition a resident every two hours causing a resident’s pressure injury to worsen. Based on interviews with staff, R1 developed stage 2 pressure injury on his/her buttocks on 5/18/23. Staff (S1 and S2) discovered a bloody scratched blister on R1’s tailbone. On the same day, S1 called R1’s responsible party requesting home health nurse to look at the wound. At 1315 hours, R1 was seen by a home health nurse who instructed staff to use Thera Honey and covered it with a bandage. Staff were taught how to clean the wound as well and to check the wound daily. Continuation LIC 9009-C, Page 1 of 3. Unsubstantiated Page 2 of 3. Furthermore, staff also stated that staff followed nurse’s instruction including repositioning, put a pad below R1 and turned him/her to either side and also put pillow behind her/him because R1 could not turn on his/her own and needed staff to turn him/her. R1’s undergarment were frequently changed every 30 minutes and checked every two hours to ensure R1’s wound did not worsen. R1’s responsible parties were provided assurance by the home Health nurse that a medical doctor was not be needed at the time. Furthermore, between 05/20/23 until R1’s hospitalization on 05/26/23, the facility staff and ADM appraise R1’s responsible parties on R1’s condition. Interviews with staff and ADM, they were instructed by a Home Health Nurse to clean wound, change the dressing [when nurse is not available] and reposition R1 every two hours. Based on the facility record review, staff documented they turned R1 every two hours as instructed, in addition to, cleaning and changing his/her dressing and request for additional supplies from home health but never received any per ADM. ADM purchased supplies instead but R1’s pressure injury continued to worsen. The facility Administrator (ADM) stated that he/she reached out to R1’s responsible party numerous times to request additional home health visits, wound care supplies, as well as a referral to be seen at a wound care clinic. Staff contacted reporting party on 05/20, 05/21, 05/22 about R1’s medical heath condition. R1 was seen by reporting party and a home health nurse between 05/18 to 05/24/23. Page 3 of 3. ADM also stated he/she demanded a home health visit to R1’s responsible party as well as MD consult on what to do. ADM stated he/she asked R1s responsible party why there was a delay from the MD to refer R1 to wound clinic, and even offered to speak with the MD herself/himself. ADM contacted R1’s responsible party couple of times to follow up on the referral but no available schedule appointment at the wound clinic instead R1 was seen by his/her PCP on 5/26/23. ADM stated he/she found out later that there was some confusion on the order to the wound clinic and was told it would take 6 weeks for everything to be sorted and an appointment made wherein ADM informed responsible party that R1 really needed to be seen by MD, and finally, R1 was seen by MD. ADM stated that R1’s responsible party brought R1’s a doughnut pillow to sit on because the pain only occurred when R1 sat down but never complained of pain during his/her showers, nor R1 never told staff that he/she was in pain. ADM also added that R1 did not want staff touching him/her or clearing his/her private areas, and staff were instructed to respect R1’s personal rights. On 05/27/23, R1 was sent to the hospital after PCP’s assessment of R1’s wound during his/her appointment. While at hospital, R1’s wound was at Stage 4 and he/she required immediate debridement surgery and further treatment was provided. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee (LIC) Dominica Olivia. A copy of the report was provided.the state’s words, verbatim · CDSS document, Feb 13, 2024 · control 26-AS-20230815094915

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: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai conducted an case management visit to address information obtained during the complaint investigation 8/15/2023. LPA Rai met with Licensee, Dominica Olivia and stated the purpose of the visit. During investigation, it was disclosed that the caregivers were providing wound care to resident (R1) and the caregivers are not licensed providers. During today's visit, LPA interviewed Licensee regarding the issues disclosed during investigation. Licensee stated caregivers who are not licensed providers did change R1's wound care when Home Health nurse were not available and did not see R1 at the facility. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. This report was reviewed with Licensee Dominica Olivia. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Feb 13, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87631(a)(3)(A) · Plan of correction due date: Feb 14, 2024

87631 Healing Wounds (a)(3)(A) The resident shall receive care for the pressure injury from a physician or an appropriately skilled professional. This requirement is not met as evidenced by: Based on interview, resident (R1) received care for the pressure injury by a non-skilled professional and the wound care was provided by the caregiver which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 13, 2024

Plan of correction: Licensee stated to submit a written plan of action and initiate in-service training with the staff by POC due date. Licensee agreed and understood.