Villariana Care

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:45 a.m., the LPA met with staff and explained the reason for the visit. At 10:01 a.m., the Co-Administrator, Johnna Udden arrived at the facility. At 10:15 a.m., Administrator, Helen Rose T. Busch arrived at the facility. RECORD REVIEW: Between 10:02 a.m. and 11:30 a.m., the LPA conducted a file review for all five (5) residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. The LPA observed documentation for the Infection Control Plan and Emergency and Disaster Plan. The last emergency disaster drill took place on 11/30/2025. At 12:34 p.m., the LPA conducted a review of medication and medication documentation with Co-Administrator, Johnna Udden for three (3) residents. Medications are located in locked cabinets adjacent to the kitchen and living room. At 1:01 p.m., the LPA, along with Co-Administrator, Johnna Udden toured the physical plant areas inside and outside to ensure there are no health and safety hazards. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 1:01 p.m., hot water measured at 110.1-degree Fahrenheit. Continued on LIC-809-C. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) staff room and three (3) bathrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside the temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid materials. Hot water measured within required range, between 105.3- and 107.4-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. OUTDOOR SPACE: At 1:05 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There are two (2) self latching gates on the sides of the house designated for an emergency exit. The garage is attached and remains inaccessible to residents. Laundry units are located inside the garage. Cleaning solutions are located inside the garage. Additional food supplies and water are also stored in the garage. There are no bodies of water on the premises. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. At 11:10 a.m., the LPA observed the residents and staff participating in a live music activity. The LPA observed the fire extinguisher to be fully charged and last serviced on 10/06/2025. At 1:10 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. There is a working telephone on premises. The LPA observed additional clean linens and towels in the hallway cabinets. The fireplace was adequately screened at the time of the visit. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Dec 11, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced Required - 1 Year Continuation inspection and arrived at the facility at 10:30 a.m. This is a continuation from the 12/23/2024 Required - 1 Year inspection. Upon arrival, LPA was greeted by staff and Co-Administrator. Today, the LPA met with Co - Administrator Helen Rose T. Busch and explained the reason for the inspection. Co- Administrator Johnna Udden arrived during the inspection. At 10:34 a.m- 10:50 a.m the LPA briefly toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. RECORDS: Records review began at 10:53 a.m., Four (4) Personnel records including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. At 11:10 a.m. five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All files were in order at this time. EMERGENCY DISASTER PLAN: LPA reviewed the facility's emergency disaster plan, which was recently updated. Emergency drills are conducted quarterly, with the last completed drill documented on 11/15/2024 and the next one scheduled for February. INFECTION CONTROL PLAN: During today's visit, LPA reviewed the facility's infection control plan. The facility's policies and procedures related to infection control are adequate. (Report Continued on LIC 809C...) (Report Continued from LIC 809C...) INTERVIEWS: Two (2) staff interviews and two (2) resident interviews were conducted during the inspection. Staff interviews revealed that staff are knowledgeable in resident rights, different forms of abuse and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. During today’s visit, the LPA obtained copies of the following: LIC 500 Personnel Report, LIC 9020 Resident Roster, and current liability insurance. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report reviewed and provided.the state’s words, verbatim · CDSS document, Jan 21, 2025

Type of visit: Required - 1 Year

At 1:20 p.m. Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the visit. Staff called the Administrator who arrived shortly after. LPA met with Co-Administrator Johnna Udden and informed them of the reason for the visit. At 1:25 p.m. the LPA conducted a tour of the physical plant with the Administrator to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of four (4) resident bedrooms, one (1) staff room, and three (3) restrooms. The LPA observed one (1) fire extinguishers which was fully charged and last serviced 10/09/2024. At 2:31 p.m. all smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the entrance area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Kitchen: The LPA inspected the kitchen/food service area at 1:35 p.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. Chemical storage is kept locked under the sink. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 115.1 degrees Fahrenheit at 1:42 p.m. Bedrooms: The four (4) resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. (PAGE 1) Report Continued on LIC 809C PAGE 2... (PAGE 2) Report Continued from LIC 809 PAGE 1... RESTROOMS: There are three (3) restrooms of which two (2) are designated for resident use. Resident restrooms were observed to be equipped with nonskid surfaces. Grab bars were observed in both bathrooms. The restrooms were sufficiently stocked with supplies and paper towels. The water temperature was measured in both resident restrooms between 106.9-108.1 degrees Fahrenheit all within the required range. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The last emergency disaster drill took place on 11/15/2024. Activities were observed in the common areas. The fireplace was adequately screened at the time of the visit. GARAGE/BACKYARD: The garage is maintained locked at all times. LPA observed an adequate amount of emergency food and water. Cleaning supplies are kept in the garage locked and inaccessible to residents in care. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water noted at the time of the visit. Laundry detergent was observed in a locked cabinet in the garage. LPA observed two (2) self latching gates. MEDICATIONS: Medications review began at approximately 2:01 p.m. The medications are in a locked cabinets adjacent to the kitchen and living room. Medications for five (5) residents were reviewed. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. No medication errors observed at this time. Interviews: The LPA conducted two (2) staff and two (2) resident Interviews. Interviews reveled that staff are knowledgeable in resident rights, forms of abuse and reporting procedures. No immediate concerns were voiced at the time of the visit. Documents obtained: LIC 500 Personnel Report, LIC 9020 Resident Roster, and Liability Insurance. Due to time constraints an LPA will return to complete the annual at a later date. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 23, 2024

Type of visit: Required - 1 Year

At 09:00 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by Administrator Assistant Johnna Udden and informed them of the reason for the visit. Administrator Helen Rose T. Busch arrived shortly. At 09:15 a.m. the LPA conducted a tour of the physical plant with the Administrator to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of four (4) resident bedrooms, one (1) staff room, and three (3) restrooms. The LPA observed one (1) fire extinguishers which was fully charged and last serviced 10/16/2023. At 9:25 a.m. all smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the entrance area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Kitchen: During the facility tour the kitchen appeared clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Snacks and beverages are always available for the residents. At 9:17 a.m. the LPA observed a pair of scissors inside a drawer of the kitchen island, and a pair of kitchen scissors in the dish drying basket next to the sink. Upon observation, staff locked away both pairs of scissors. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Report will continue on LIC809-C. Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. At 09:28 a.m. water temperature in residents restroom was measured at 120 degrees Fahrenheit. A conversation was held with the administrator of best practices to ensure water temperature does not exceed 120 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The facility maintained a comfortable temperature of 68 degrees. There were no obstructions and/or tripping hazards throughout the facility. The garage: The LPA observed the garage, where the washer and dryer are held, and the emergency food and water is stored. Cleaning supplies and disinfectants are kept in locked cabinets in the garage. The garage is not locked. At 9:51 a.m. the LPA observed a box labeled “Tools” with an assortment of tools such as pliers and a hammer. The LPA observed power tools, and paint in the garage as well. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. Infection Control: The home has an adequate supply of Personal Protection Equipment (PPE) and can obtain additional supplies. The home’s policies and procedures pertaining to infection control were adequate. Medications: At 10:01 a.m. a medication review was initiated, and the following was observed. Medications are centrally stored and locked in a cabinet in the kitchen inaccessible to residents in care. During Resident #1 (R#1's) audit, the LPA observed Donepezil HCL not properly documented on the centrally stored medication and destruction log, as the expiration date, date filled, and refills did not match the prescription label. During R#2's audit, the LPA observed Levothyroxine not properly documented on the centrally stored medication and destruction log as the strength, date filled, and expiration date did not match the prescription label. During R2’s med audit, the LPA also observed a bottle of Diltiazem CD with the expiration date of 11/2/2023, and observed Quetiapine not properly documented as there was no record of it being administered in the mornings, and per the prescription it should be administered every morning and at bedtime. Upon observation, staff documented the correct information. Report will continue on LIC809-C. Record Review: At 11:20 a.m. a review of facility files was initiated. The LPA reviewed five (5) out of five (5) resident files, and the following was observed. Two out of five residents (R3,R4) do not have Consent for medical treatment forms LIC627C in their files. One out four residents (R3) did not have a Tuberculosis result on file. The LPA reviewed five (5) of five (5) staff files. The LPA reviewed five staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid/CPR cards. All files were complete. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill (conducted on 11/01/2023). The LPA obtained a Client Roster, Staff Roster, and copy of Insurance liability. Interviews: The LPA conducted two (2) staff and two (2) resident Interviews. No immediate concerns were voiced. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to Administrator Helen Busch.the state’s words, verbatim · CDSS document, Dec 8, 2023

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.