Virginia Denise Country Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hiratsuka arrived unannounced at the facility to conduct a required annual inspection utilizing the inspection tool. LPA met with Administrator and explained the purpose of the visit. LPA and Administrator conducted a tour of the facility to ensure the health and safety of residents in care. Areas toured included but not limited to: residents bedrooms, bathrooms, kitchen and the common areas. LPA observed residents in care to be eating and supervised by direct support professional. LPA observed residents rooms to be clean and sanitary. LPA observed sharps, toxins and medications to be locked and secured. LPA observed facility to have adequate activities available for residents in care. In areas toured, no immediate health, safety, personal rights violations were observed. File review was conducted for residents and personnel records. Additionally, LPA conducted file review of facility fire drills records. No deficiencies cited. Exit interview was conducted with Administrator. A copy was provided.the state’s words, verbatim · CDSS document, Jun 16, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection utilizing the inspection tool. LPA met with Administrator and co-Administrator and explained the purpose of the visit. LPA and co-Administrator conducted a tour of the facility to ensure the health and safety of residents in care. Areas toured included but not limited to: residents bedrooms, bathrooms, kitchen and the common areas. LPA observed fire extinguishers present throughout the facility, recently serviced November 15, 2024. LPA observed residents in care to be eating and supervised by direct support professional. LPA observed residents rooms to be clean and sanitary. LPA observed sharps, toxins and medications to be locked and secured. LPA observed facility to have adequate activities available for residents in care. In areas toured, no immediate health, safety, personal rights violations were observed. File review was conducted for residents and personnel records. Additionally, LPA conducted file review of facility fire drills records. LPA and Administrator discussed updating the Emergency Disaster Plan to the updated nine page form. A copy was provided. At this time, LPA is requesting a copy of facility liability insurance to be emailed to LPA. CARE tool was completed with Administrator and found facility to be compliance. No deficiencies cited. Exit interview was conducted with Administrator. A copy was provided.the state’s words, verbatim · CDSS document, Jul 30, 2025

Type of visit: Case Management - Deficiencies

On 1/21/2025, Licensing Program Analysts (LPAs) Cassie Yang and Kayla Adkison arrived unannounced at the facility to conduct a case management visit regarding the recent Title 17 monitoring review conducted on 12/17/2024. LPAs met with Administrator and explained the purpose of the visit. LPAs and Administrator discussed the deficiencies observed by Alta California Regional Center. Administrator stated prescribed medication was administered to C1 but staff had failed to document the following in C1's medication administration record. Administrator stated during date of administration, there was "chaos" in the morning routine which caused facility staff to failed signing the last medication. Administrator informed LPAs in-service training has been conducted to ensure the 7 Rights of Medication Administration. As a result of today's visit, deficiencies cited. Exit interview conducted, and a copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 21, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jan 31, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on file review, the Licensee did not comply as C1's prescribed medication was not signed off as administered for 12/15/2024, which poses a potential risk for residents in care.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: Licensee conducted an in-service training of 7 Rights of Medication to all staff. Correction will be cleared.

Type of visit: Required - 1 Year

On June 19, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a yearly annual inspection. LPA met with Aileen Fermo, Licensee and informed her the reason for the visit. The Administrators Certificate expired in October 2025. Aileen and LPA completed the Infectious Control questionnaire with no issues or concerns. LPA was unable to interview staff and clients due to them not at home. This is a 4 bedroom home. All rooms had the required items of furniture such as bed, dresser, and closet. The restrooms were clean and consisted of grab bars and non skid mats. All toilets, tubs and showers were in good working order. The facility has a working washer and dryer plus enough linen for the residents. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food. There’s appropriate lighting throughout the facility. There are no bodies of water on the premises. The smoke alarm was working. The Medication Administration Record was viewed and found to be completed. The facility's temperature was 74 degrees F. Living room, dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be enough and in good repair. To continue see 809-C.. First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, and carbon monoxide detectors operate properly. Fire extinguisher is maintained and ready for emergency use. LPA inspected the exterior grounds of this facility. This facility sits on 2 acres and the backyard is landscaped. There’s a centralized storage area for resident’s medication. Medication cabinet was locked. Staff records reviewed indicated current First Aid & CPR certificates. Facility is conducting staff training as required. LPA reviewed 2 client files. Files had the the proper updated documents in them. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed. ****The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610E the Emergency Disaster Plan, and copy of your current Liability Insurance to update the facility file in our Regional Office. Administrator shall submit the listed documents to Licensing no later than July 19, 2024.*******the state’s words, verbatim · CDSS document, Jun 19, 2024

Type of visit: Case Management - Other

On 03/06/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a required 1 year annual inspection. LPA met with Administrator Aileen Fermo and explained the purpose of the visit. LPA and Administrator discussed that the annual is due for their facility Cantor- Fermo Residential Home #2 which at the front of the street. As this annual is not until July. Administrator informed LPA she will meet LPA at the other facility. LPA vacated the premises. Exit interview, a copy of report was provided.the state’s words, verbatim · CDSS document, Mar 7, 2024

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Cassie Yang and Cheyenne Ratajczak arrived unannounced at the facility to conduct a case management visit. LPAs met with Administrator, Aileen Fermo, and explained the purpose of the visit. LPAs and Administrator discussed the importance of reporting requirement with the Department. LPAs explained the Department has not received LIC 624A Death Report for R1. LPAs explained it is Licensee's responsibility to provide a written report within seven (7) days of the occurrence. Administrator stated Alta California Regional Center (ACRC) representative provided the requested documents. LPA Yang stated she was unable to confirm the following as LPA Yang attempted contact with ACRC on 10/2/2023 and 10/4/2023 but was unsuccessful. Additionally, LPA Yang did not receive any documents via email as requested. As a result of today's visit, deficiencies was cited. Please see LIC 809-D. Exit interview concluded, a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Oct 4, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Oct 4, 2023

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement is not met as evidenced by: Based on interview and file review, Licensee did not comply with the section cited above as LPA Yang did not receive the LIC 624A for R1 as requested during a visit conducted on 9/22/2023, which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Oct 4, 2023

Plan of correction: Licensee is to submit LIC 624A Death Report for R1 to LPA Yang via email by close of business 5PM on Wednesday October 4, 2023.