Weaver's Lilac Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregivers Liza Cruz and Lucy Luo. Administrator Juliane Cruz arrived shortly after LPA, joining halfway through the physical walk through of the home. The facility's license shows a maximum capacity of six (6) residents, where one (1) of which may be bedridden. Bedridden may only reside in bedroom #1. Additionally the facility is approved for six (6) hospice waivers. During today’s inspection there were six (6) residents in care, with three (3) on hospice. LPA, Caregiver Luo, and Administrator Cruz toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Common bathroom sink by front entryway was 110.1F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to residents in care. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Cruz, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher was purchased within the last 12 months, dated for October 2025. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed two (2) staff and one (1) client, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator Cruz to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jun 18, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Rebecca Borunda conducted a plan of correction visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Administrator Juliane Cruz. The purpose of the visit was to verify if the two deficiencies issued on 6/19/2025 had been corrected. On 6/19/2025, the licensee was issued a deficiency of regulation 87615(a)(2) with a correction due date of 6/27/2025 and a deficiency of regulation 87465(e) with a correction due date of 7/7/2025. As of today’s date, 7/15/2025, the Department had not received proof of correction for either deficiency. According to Administrator Cruz, POC paperwork had been faxed to the Department on 6/27/2025 and 6/30/2025, however there were issues with the fax machine and LPA Borunda did not receive the POC documents. During today’s visit, LPA Borunda reviewed resident and staff paperwork. Review of Resident 1's paperwork revealed that R1 was admitted to hospice services on 6/26/2025, which means that an exception request for R1's prohibited health condition is no longer required. Therefore, deficiency 87615(a)(2) has been corrected. Review of staff training paperwork revealed that staff received medication training on 6/26/2025. Therefore, deficiency 87465(e) has been corrected. LPA provided Administrator with letters of Deficiency Cleared for both deficiencies. An exit interview was conducted with Licensee Tonya Weaver via telephone and Administrator Juliane Cruz, whose signature below confirms receipt of a copy of this report, the Letters of Deficiency Cleared, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jul 15, 2025

Allegation investigated: Questionable Death

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Juliane Cruz. The Department’s investigation consisted of interviews with residents and staff, review of facility records, and a tour of the facility. It was alleged that a medication error resulted in Resident 1’s (R1) death. Review of R1’s assessment records dated June 2022 and interviews with staff revealed that R1 had a diagnosis of esophageal cancer, had a tracheostomy, was not confused or disoriented, but was able to communicate needs and follow instructions. Review of R1’s medical records from April 2023 and assessment records dated June 2022 revealed that R1 was receiving hospice services for esophageal cancer and was discharged from hospice services in December 2022. Continued on LIC9099-C page... Unsubstantiated Review of R1’s medication list for May 2023 revealed that R1 had been prescribed numerous medications, including one routine pain medication and five as needed (PRN) medications for pain relief, one of which was the pain medication hydromorphon 2mg. Review of R1’s medication list between November 2022 and May 2023 revealed that R1 was prescribed hydromorphon 2mg as needed every 2 hours. Interviews with staff revealed that the facility did not keep a Medication Administration Record (MAR) for routine medications, but did maintain a MAR for PRN medications, including R1’s hydromorphon. Interviews with staff and review of R1’s death certificate revealed that R1 had a surgical operation to correct a complication from R1’s tracheostomy on 5/11/2023. Review of R1’s MAR for hydromorphon revealed that following R1’s surgery on 5/11/2023, R1 was given 2mg hydromorphon on 5/13/2023 at 11:30am and 2:00pm. R1 received additional doses of hydromorphon at 5:00pm, 8:00pm and 11:00pm, however, those doses had a handwritten note next to each dose that the dose given was 3mg. On the following page of R1’s MAR, another handwritten note stated that the doctor changed the dose and frequency to 3mg every 3 hours. The MAR revealed that R1 received 3mg of hydromorphon approximately 3 hours apart. Interviews with staff revealed that R1 was very aware of R1’s medication schedule and routine, and would frequently ask for their prescribed medications, including pain medications more often than the medication was allowed by the doctor’s order. Review of R1’s death certificate revealed that R1’s cause of death was listed as tongue cancer, and did not list any conditions related to medications contributing to R1’s death. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with Administrator Juliane Cruz, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jun 19, 2025 · control 08-AS-20240904091815

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to deliver an amended LIC9099 report. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Syueer "Lucy" Luo. Administrator Juliane Cruz arrived during the visit. During today’s visit, LPA obtained Juliane Cruz’s signature on the amended complaint report dated 9/11/2024. An exit interview was conducted with Administrator Juliane Cruz, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jun 19, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to cite for a deficiency discovered during a complaint visit that is unrelated to the complaint allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Juliane Cruz. During the unrelated complaint visit, it was determined that Resident 1's (R1) file did not contain a written doctor's order for a medication change. Review of R1’s medication list between November 2022 and May 2023 revealed that R1 was prescribed hydromorphon 2mg as needed every 2 hours and to not exceed 12 doses within 24 hours. Review of R1’s Medication Administration Record (MAR) for hydromorphon revealed that following R1’s surgery on 5/11/2023, R1 was given 2mg hydromorphon on 5/13/2023 at 11:30am and 2:00pm. R1 received additional doses of hydromorphon at 5:00pm, 8:00pm and 11:00pm, however, those doses had a handwritten note next to each dose that the dose given was 3mg. On the following page of R1’s MAR, another handwritten note stated that the doctor changed the dose and frequency to 3mg every 3 hours. The MAR revealed that R1 received 3mg of hydromorphon approximately 3 hours apart. Review of R1’s physician’s orders revealed that R1 did not have any written orders to change the dose and frequency of hydromorphon. Therefore, a deficiency regarding written doctor's orders is being cited per California Code of Regulations Title 22 and noted on the attached LIC809-D page. An exit interview was conducted with Administrator Juliane Cruz, whose signature below confirms receipt of a copy of this report, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jun 19, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e) · Plan of correction due date: Jul 7, 2025

87465 Incidental Medical and Dental Care (e) For every prescription and nonprescription PRN medication...there shall be a signed, dated written order from a physician... maintained in the residents file... This requirement has not been met as evidenced by: Based on record review, the licensee did not ensure that R1's file had a written doctor's order for R1's PRN pain medication after the doctor updated the prescription. This posed a potential health risk to 1 of 6 residents in care.the state’s words, verbatim · CDSS document, Jun 19, 2025

Plan of correction: Administrator stated that staff will not follow doctor's verbal orders until the facility has a copy of the written doctors order for all medications or changes in dose and frequency. Administrator will provide in-service training for staff regarding medication administration and doctor's orders and provide the training sign in sheet to the Department by POC due date of 7/7/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Juliane Cruz. LPA spoke with Licensee Tonya Weaver via telephone during the visit. The facility is licensed for a maximum capacity of 6 nonambulatory residents, 1 of which may be bedridden in bedroom #1. The facility has a waiver for 6 hospice residents. During today’s visit, the facility had a census of 6 non-ambulatory residents. The Administrator for the facility is Juliane Cruz and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 107.4 and 106.0 degrees Fahrenheit in common bathrooms. The facility’s internal temperature was measured at 79 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Juliane Cruz, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. Continued on LIC809-C page… The facility refrigerator was kept at 36 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. LPA reviewed multiple resident and staff records. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. Each resident record was complete and contained a signed admission agreement, initial medical assessment, updated annual reappraisal, documents regarding safeguarding personal property, and personal rights. Review of Resident 1's (R1) medical and care assessments as well as discharge paperwork dated April 2025 revealed that R1 had a diagnosis of a gastronomy tube and was only receiving home health services. Interviews with the Administrator and Licensee confirmed that R1 was not receiving hospice services and caregivers had been trained by home health staff on proper gastronomy tube care. LPA provided guidance and consultation with Administrator regarding regulation changes that became effective 1/1/2025. The following deficiency was cited for prohibited health conditions and noted on the attached LIC809-D page. An exit interview was conducted with Licensee Tonya Weaver and Administrator Juliane Cruz, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jun 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Julianemarie Cruz. Administrator Tonya Weaver arrived during the visit. The facility is licensed for a maximum capacity of 6 non-ambulatory residents, 1 of which may be bedridden. The facility has a waiver for 6 hospice residents. During today’s visit, the facility had a total census of 6 residents, 5 non-ambulatory residents and 1 ambulatory resident. LPA did not observe any aspects of delayed egress or secured perimeter. On 3/4/2024, the Department received a Change of Administrator request for Lisa Anderson-Hines and the change request is still pending with the Department. Anderson-Hines certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 110.7 degrees Fahrenheit and 117.1 degrees Fahrenheit in two common bathrooms. The facility’s internal temperature was measured at 72 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Weaver, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and label. LPA observed a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 36 degrees Fahrenheit, and the facility freezer was kept at -10 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Continued on LIC809-C page… Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and residents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns. The Administrator will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, facility sketch, and current liability insurance to the Department within 15 business days. No deficiencies were cited on today’s date. An exit interview was conducted with Administrator Tonya Weaver, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Mar 27, 2024