Violet Residential Care 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Violeta Amurao and discussed the purpose of the visit. The facility currently has four clients in care. The facility is a one-story house with four resident bedrooms, one staff bedroom, three bathrooms, a living room, a kitchen, a dining room, laundry room and a garage. The facility appears clean, safe and sanitary. LPA observed the resident bedrooms to have the required components and furnishings. The staff room had no items that should be inaccessible to residents in care. LPA observed the bathrooms to have toilet paper, paper towels and textured shower flooring. The water was tested between 111.5-113.5 degrees Fahrenheit. LPA observed a clean supply of linens in two hall closets near the bedrooms. LPA observed all auditory devices to be operational. LPA observed the kitchen to be clean and free of vermin. A two day perishable and seven day non perishable food supply was on hand. The knives were located in a locked kitchen drawer and made inaccessible. Toxins are locked under the kitchen sink and in a locked cabinet in the pantry. All appliances were found to be operational. LPA observed the centrally stored medication to be in a locked cabinet in the living room and made inaccessible. The first aid kit had all the required components. LPA observed a shaded seating area in the backyard with no debris or obstructions. The gates were unlocked and easy to open. AD tested the carbon monoxide and smoke detectors and they were found to be operational. Fire extinguishers were observed throughout the facility charged. Continue on LIC 809C LPA reviewed staff files and no discrepancies were observed. LPA reviewed the emergency disaster plan and it has not been updated/reviewed since April 14, 2025. LPA reviewed resident files and no discrepancies were observed. LPA reviewed the centrally stored medication and no discrepancies were observed. The last emergency disaster drill was conducted on April 8, 2026. All staff present are background cleared and associated to the facility. LPA provided Legionnaires’ Disease Fact Sheet at the time of the inspection. Based on today’s observations a deficiencies is being noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with LIC809D and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jun 19, 2026

Allegation investigated: Staff did not provide a safe environment for the resident. Staff did not safeguard resident's personal belongings. Staff did not report incident to resident's responsible party.

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on April 24, 2026. LPA was greeted and granted entry into the facility and met with Administrator (AD) Violeta Amurao. LPA explained the reason for the visit. This Department has investigated the complaint alleging that staff did not provide a safe environment for the resident. Regarding the allegation the following was revealed: During the interviews with individuals four of six denied the allegations. During the investigation LPA reviewed the Unusual Incident/Injury Report (UIIR) dated April 23, 2026, for Resident 1 (R1). Per UIIR, on April 20, 2026, R1 claimed that R2 hit her on the left side on her face. Per UIIR, Staff 1 (S1) reported that he observed both residents standing apart and stated that he did not hear any yelling or disturbance. During the interviews with residents, R1 reported that she does not feel safe because R2 grabbed her walker and shoved her back while slapping her in the face. Per R2 and R3, they feel safe and/or reported that staff are attentive with the residents. CONTINUED ON LIC9099-C... Unsubstantiated Regarding the allegation that staff did not safeguard resident's personal belongings, the following was revealed: During the interviews with residents, R1 reported that R2 tried to take her walker away. Per R2 and R3, staff always safeguard their personal belongings. During the interviews with staff, S1 reported that R2 did not take away R1's walker. Per AD, R2 did not take away the walker from R1. AD reported that if R2 had hit R1 that R1 would have bruises. Regarding the allegation that staff did not report incident to resident's responsible party, the following was revealed: LPA reviewed the UIIR for R1. Per UIIR, the unwitnessed incident was reported to R1 and R2's daughters. During the interviews with residents, R1 reported that she is not aware if the AD notified her family. Per R2 and R3, staff report incidents to their family. During the interviews the AD reported that she talked to both residents' daughters. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED. For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations. LPA conducted an exit interview with AD Amurao, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 17, 2026 · control 22-AS-20260424093154

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicant Violeta Amurao and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on March 10, 2025. The facility is to have a capacity of six residents, (0) ambulatory, (5) non-ambulatory and (1) bedridden residents. Applicant requested a Hospice Waiver for (5). Facility phone number is (714) 884-3046. LPA observed the following. Structure: The facility is a one-story house with four resident bedrooms, one staff bedroom, three full size bathrooms, a living room, a kitchen, a dining room, and a garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall by the staff office. There are two gates, each located on the front of the house. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are four resident bedrooms. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. CONTINUED ON LIC809-C... Bathrooms: All bathrooms are clean and have working plumbing. Hot water measured between 112.1-113.5 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen for each resident was stored in the closet by the residents' bedroom hallway. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menu was available. Food Service: There are no residents living in the facility at this time. There is 7-day non-perishable food supply on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. Fire extinguishers were charged, mounted and one was located by the entryway and one by the kitchen. Appliances: There is one gas stove, one oven, microwave, a refrigerator, washer and dryer. All appliances are clean and operational. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored in locked cabinet in the laundry room. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 112.1-113.5 degrees Fahrenheit. CONTINUED ON LIC809-C... Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in a cabinet in the staff's office. The first aid kit has all the required elements. Medications will be stored in locked cabinet in the staff's office. Resident & Staff Files: The resident and staff records will be kept in a locked cabinet in the staff's office. Reading Material, Games, Equipment & Materials: The activities plan include magazines, gardening, books, boards games and exercise activities. Fire clearance: Fire Clearance approved by a fire inspector of Orange County Fire Authority on April 9, 2025. Special conditions noted, "Bedroom 1, 2, and 3 are approved for nonambulatory clients. Bedroom 4 is approved for 1 bedridden client." Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. LPA advised Applicant to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for inquiries and to submit incident reports. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB (Central Applications Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Jun 19, 2025

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Amurao, Violeta On 5/30/25, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/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, May 30, 2025