Villariana Care II

Type of visit: Required - 1 Year

At 12:30 p.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA met with staff and explained the reason for the visit. Co-Administrator Johnna Macanin arrived shortly thereafter and informed them of the reason for the visit. At 12:45 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 two (2) private bedrooms and two (2) shared bedrooms. Bedroom #2 has direct access outside. The LPA observed fire extinguishers which were fully charged and purchased on 04/7/2026. 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. Kitchen: The facility has at least seven (7) day supply of non-perishable food and two (2) days perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives, sharps, and cleaning supplies were observed in locked cabinet. Water temperature in the kitchen was measured at 109.2 degrees Fahrenheit. Bedrooms: Each bedroom is equipped with clean mattresses, pillows, and bedding. There is a closet in the hallway with a sufficient supply of linens, including blankets, bath towels and wash cloths. Bedrooms have sufficient lighting. Bathrooms: There is two common restrooms in the hallway and one private restroom in bedroom #2.The LPA observed bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. Water temperature in the private restroom was measured at 106.5 degrees Fahrenheit. Report will continue on LIC809-C, 2nd page. Common Areas: The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. A working telephone is present. There are activity supplies in the living rooms. All doors have functioning auditory alarms when opened. The garage/Laundry room: The laundry room holds the washer, dryer and detergent and was observed locked and inaccessible to the residents in care. The garage is accessible from the house; the doors were locked from the inside of the house. Toxic or danger items or tools in the garage, were locked in a cabinet during the visit. Emergency food and water is stored in the garage. Surrounding Grounds (Outdoors): The exterior passageways were clean and clear of any obstructions. There is a covered patio area with outdoor seating. The entire property is fenced. The back and sides of the house are separated from the front yard by a gate and fence. No bodies of water were observed. Record Review: A review of facility files was initiated. The LPA reviewed five (5) out of six (6) resident files. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. The LPA reviewed five (5) out of six (6) Personnel files. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Staff were missing 2 hours of medication training. Upon observation the Administrator indicated that they had received a training plan from a third party vendor who did not specify 8 hours medication training were required and will have staff conduct the missing hours needed. Otherwise, all files were in order. Facility records are stored in the locked cabinet in the living room. The LPA observed documentation of Infection Control, and Emergency Disaster Plan. The LPA obtained Client Roster, Staff Roster and Insurance liability. Medication Audit: The LPA conducted Medications audit for two (2) residents. The medications are locked in a locked cabinet in the living room. Medications are labeled and checked for expiration dates. Medications are documented on the centrally stored medications and destruction record. Interviews: The LPA conducted two (2) resident and two (2) staff Interviews. No immediate concerns were voiced by the residents. Exit interview conducted and copy of the report and appeal rights provided to the Administrator.the state’s words, verbatim · CDSS document, Jul 7, 2026

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: Required - 1 Year

At 09:35 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA met with C0-Administrator Johnna Macanin and informed them of the reason for the visit. At 09:45 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 two (2) private bedrooms and two (2) shared bedrooms. Bedroom #2 has direct access outside. The LPA observed fire extinguishers which were fully charged and purchased on 05/17/2025. 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. Kitchen: The facility has at least seven (7) day supply of non-perishable food and two (2) days perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives, sharps, and cleaning supplies were observed in locked cabinet. Bedrooms: Each bedroom is equipped with clean mattresses, pillows, and bedding. There is a closet in the hallway with a sufficient supply of linens, including blankets, bath towels and wash cloths. Bedrooms have sufficient lighting. Bathrooms: There is two common restrooms in the hallway and one private restroom in bedroom #2.The LPA observed bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. At 09:58 a.m. water temperature in the private restroom was measured at 111.2 degrees Fahrenheit and at 115.2 degrees Fahrenheit in one of the common bathrooms. Report will continue on LIC9099-C, 2nd page. Common Areas: The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. A working telephone is present. There are activity supplies in the living rooms. All doors have functioning auditory alarms when opened. At 10:15 a.m. the LPA observed the Administrator administered medication to a resident by feeding it to them via a spoon. The garage/Laundry room: The laundry room holds the washer, dryer and detergent and was observed locked and inaccessible to the residents in care. The garage is accessible from the house; the doors were locked from the inside of the house. Toxic or danger items or tools in the garage, were locked in a cabinet during the visit. Emergency food and water is stored in the garage. Surrounding Grounds (Outdoors): The exterior passageways were clean and clear of any obstructions. There is a covered patio area with outdoor seating. The entire property is fenced. The back and sides of the house are separated from the front yard by a gate and fence Record Review: At 11:10 a.m. a review of facility files was initiated. The LPA reviewed five (5) out of six (6) resident files. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. The LPA reviewed five (5) out of seven (7) Personnel files. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Facility records are stored in the locked closet in the living room. The LPA observed documentation of Infection Control, Disaster prevention and last Disaster drill (conducted on 05/01/2025). The LPA obtained Client Roster, Staff Roster and Insurance liability. Medication Audit: At 12:00 p.m. the LPA conducted Medications audit for two (2) residents. The medications are locked in a locked closet in the living room. Medications are labeled and checked for expiration dates. Medications are documented on the centrally stored medications and destruction record. During Resident 1's (R1's) audit the LPA observed an under count of Acetaminophen by one (1) pill based on the start date and quantity. Upon observation, the Administrator called the staff responsible for the medications and they stated they wrote the wrong start date in error. Interviews: The LPA conducted two (2) resident and two (2) staff Interviews. No immediate concerns were voiced by the residents. Staff interviews revealed that medications are not self-administered at times and staff put the medications into the resident's mouth. 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 the Administrator.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Esther Cortez conducted a pre-licensing visit to the above noted facility. The LPA met with applicants, Helen Rose T. Busch and Johnna Macanin. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver for five (5) has been requested. Component III was completed during the inspection with the applicants. The facility is a single story home. At 9:50 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing the home for six (6) non-ambulatory residents. The home has a sprinkler system. The facility has two (2) private bedrooms and two (2) shared bedrooms. Bedroom #2 has direct access outside. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with comfortable mattress and clean linen; which includes, top and bottom linens, pillowcases, blanket and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. The facility does not have a staff room, therefore will have 24 hour awake staff. All rooms were free of odors. All window screens were clean and maintained in good repair. There is two common restrooms in the hallway and one private restroom in bedroom #2. The resident bathrooms have showers with non-skid materials. The private restroom has a shower and a bathtub with grab bars and non-skid materials .The hot water temperature was measured as follows: resident’s private bathroom = 116.4 *F, one of two resident's common bathroom 118.9*F and the kitchen – 119.3 *F, which fall within the allowable range of 105*F to 120*F. Report continued on LIC 809-C. Resident and staff records will be stored in a filing cabinet in the hallway of the first dining room. Medications will also be centrally stored in a locked filing cabinet in the dining room. Knives and cleaning supplies will be stored in locked boxes inside drawers and cabinets in the Kitchen. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. The supply of perishable and nonperishable food is adequate. There was a three day supply of emergency water. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked closet located in the garage. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. The facility has televisions, puzzles, coloring books, books and games for activities. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to non-private bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There is a fireplace in both living rooms which were screened with no tools. The facility has emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. There is a pull station in the hallway outside of room #1 and one of the common bathrooms. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There are two fire extinguishers throughout the house. They are fully charged and do not exceed the purchase date 12/30/2023. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate. There is a functioning telephone on the premises. The emergency exiting plans/sketch, emergency telephone numbers and other required postings are posted at in the entry way of the living room. Report continued on LIC 809-C. The exterior passageways were clean and clear of any obstructions. There is a covered patio area with outdoor seating. The entire property is fenced. The back and sides of the house are separated from the front yard by a gate and fence. The garage is accessible from the house; the doors were locked from the inside of the house. Toxic or danger items or tools in the garage, were locked in a cabinet during the visit. Infection control practices were discussed with the applicant.. Facility has a 30 day supply of Personal Protective Equipment (PPE) on site. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Jul 2, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: INTL Capacity: 6 Census : 0 Method: Telephone call with CAB COMP II Participants: Johnna Macanin & Helen Busch (Licensees/Administrator) & Tammy Edwards, (Analyst). Licensees/administrator participated in COMP II via Telephone call with CAB Analyst. Identification of licensees/administrator was verified by confirming driver’s license numbers. During COMP II, licensees/ administrator confirmed the understanding of Title 22. Component II was successfully completed. Licensees/administrator were advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed licensees/administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 18, 2024