Willows Nursing Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Administrator Eden Relota arrived later. Eden Relota Administrator Certificate 7006928740 expires 11/25/26. At approximately 1:00pm LPA and caregiver toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. Room #3 had broken chest of drawers. Caregiver immediately replaced with chest of drawers from vacant room. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperatures in sinks accessible to residents in care measured at 131.8 degrees F in the kitchen, 131.7 degrees F in the main hall bath and 134.4 in room #1 which is not within the allowable range of 105 to 120 degrees F (deficiency cited, see 809D). Additionally, water in room #3 does not have much pressure and does not get hot at all. LPA and caregiver let water run for approximately 5 minutes but water still did not get hot, LPA measured 88 degrees F. Fire extinguishers were last inspected 1/30/25. They are showing as fully charged. LPA discussed with Admin servicing them each year. Admin will get them serviced within 3 business days. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 4/2/26. Facility has a backup generator for use during a power outage. LPA observed rodent droppings in closet located in the dining room. However, caregivers and Admin advised licensee gets a regular service by EcoLab every month to address on going problem. However, Admin could not produce Continued on 809C... Continued from 809... most current copy of EcoLab service report. Admin to forward to LPA by Monday, 6/8/26. LPA and caregiver observed small amount of dog feces in side yard. Residents are ambulatory and enjoy the outside area often. LPA discussed ensuring all dog feces is picked up timely. LPA, caregiver, and Admin all observed resident exit doors to have alarms but they all were not working. Caregiver replaced batteries and got them working. LPA discussed with Admin making sure all creams and sprays that have active ingredients and warning labels are inaccessible to residents in care. At approximately 2:00pm LPA conducted a review of five [5] resident records. Residents (R1 and R2) are on hospice. However, R2 did not have a hospice care plan on file (deficiency cited, see 809D). At approximately 2:30pm LPA conducted review of four [4] staff records. No deficiencies cited. At approximately 3:00pm LPA and Admin conducted a spot check of medication and medication records. R2 most current physician's orders were dated 3/25/26 and listed Albuterol HFA 90mcg but it was not listed on the Centrally Stored Medication Log (CSML)(deficiency cited, see 809D). R2 has Aripiprazole 10mg listed on doctor's orders but on CSML and bubble pack it lists 20mg. Admin to call immediately and get clarification and updated doctor's orders or medication with correct dosage (deficiency cited, see 809D). R2 clonazepam 1mg is listed on doctors orders and CSML but is has not been refilled (deficiency cited, see 809D). Per Admin, hospice nurse came today and they have refilled it and it will be delivered tonight. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Jun 5, 2026

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Eden Relota. Eden Relota Administrator Certificate 7006928740 expires 11/25/26. At approximately 9:30am LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 106.6 degrees F in the main hall bath and 107.5 in room #5 which is within the allowable range of 105 to 120 degrees F. Rm #5 missing oxygen in use sign (deficiency cited, see 809D). Fire extinguishers were last inspected 1/30/25. Smoke/Carbon Monoxide detectors located throughout the facility were operational. Facility’s last quarterly disaster drill was conducted on 1/24/25 (deficiency cited, see 809D). Facility has a backup generator for use during a power outage. At approximately 10:30am LPA conducted a review of six [6] resident records. Residents R1, R2, R3, and R4 did have TB clearance on file (deficiency cited, see 809D). Additionally, LPA discussed with Admin that some physician reports look to be fabricated in that they were photocopied and the Admin's previous facility's Continued on 809C... Continued from 809... information on the front page was either whited out or crossed out and filled in with new facility name, as well as last signature page dates changed. Admin advised that they will avoid photocopying or crossing out information on physician's reports. At approximately 11:30am LPA and Admin conducted a spot check of medication and medication records. Resident (R2) most current physician's orders were dated 2023 and listed Ciprofloxacin in 400mg as a current medication. Per Admin this medication was discontinued but Admin could not produce discontinuation order/notice (deficiency cited, see 809D) At approximately 11:45am LPA conducted review of five [5] staff records. Training records show the same date for all employees and shows in one instance of 8 hours on 2/1/25. LPA discussed with Admin, if all employees are training for 8 hours on that day, who is caring for residents. Admin advised that she did not conduct all 8 hours of training on that day, but sporadically. LPA asked Admin to see current training materials. Admin showed LPA Community Care Options (CCO) web modules with date of publication 2004, used by accessing one sign in. LPA and Admin discussed conducting training with current training materials that are at most 10 years old. Admin advised LPA they have chosen to use CCO going forward and each employees will have printable certificates that are not photocopied and filled in, but rather populated from CCO themselves. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Jun 3, 2025

The state marks this report as 9 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Office

Licensing Program Analyst (LPA) Christi Coppo had an office meeting with Applicant Danilo Geocadin for the purpose of conducting review of Comp III. Applicant has provided LPA with videos and pictures of items that were identified as needing repair during CCL Pre-Licensing inspection conducted at Willows Nursing Home on 4/30/2024. The following items were shown to be corrected/ addressed: Items required to be repaired/addressed before licensure: Fence on east perimeter replaced Ramp on west perimeter repaired Kitchen cabinet and shelf liners are new and clean Tile above cutting board on left hand side of range has been replaced Drawers on both side of range have a functional lock Screen on kitchen screen door replaced Piles of discarded items in front and back corners of east perimeter fence have been removed Report from Orkin pest control company showed clear findings for all rodents, vermin, and insects All resident rooms have a chest of drawers Room #4 and #5 have a chair Room #6 tiles have been replaced at the bottom of each side of the shower Room #1 cracked wood piece extending across the width of the left hand portion of the top of the shower has been removed and repair was conducted Room #1 dead insects on window sill removed and blinds were cleaned. Trash bins all have tight fitting covers Extension cords on west corner of facility removed Vent in hallway on ceiling is now clean Continued on 809C... Continued from 809... All items indicated on Pre-Licensing Inspection report, dated 4/30/2024, as needing repairs/corrections have been repaired/corrected satisfactorily. Additionally, LPA called the Orkin Pest Company to verify that the handwritten note on the pest report applicant provided to LPA was accurate. The note indicated that the "birds that the applicants have as pets have a new area at which they are housed; this area is safer for rodents to not invade the home." Comp III reviewed, exit interview conducted with Applicant, and a copy of this report given. LPA will submit facility's application for approval.the state’s words, verbatim · CDSS document, Jun 12, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christi Coppo arrived announced to conduct a pre-licensing inspection and was greeted by applicant Danilo Geocadin. Facility currently does not have residents in care. Facility has fire clearance for six [6] non ambulatory residents. Once obtained, applicant will submit proof of required liability insurance. At approximately 9:30am LPA and Applicant toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed emergency supply of non-perishable food and water. Kitchen has locked cabinet that will be used for medication storage. Kitchen range has child proof knob covers. Items in kitchen that need to be addressed are: kitchen cabinet shelf liners need to be replaced or cleaned as there is yellow and orange film present; portion of counter covered with tape to cover exposed area, tile is missing above cutting board on left hand side of range; drawers on both side of range need a functional lock as drawers will house sharp knives and utensils; screen on kitchen screen door is separating from the frame. Sample menu present in dining area. Cleaning supplies locked under sink in kitchen. LPA observed two [2] rodent traps present in living room. Per Applicant, they had a pest control inspection. Applicant provided LPA with copy of report dated 10/19/2023. Per pest inspection report, various traps placed around the house, in the garage under the heater, under the backyard deck, and technician placed an excluder in the two holes where the entry point was, a trap in front of one small hole located in the garage, and noted their concern for the birds outside. Applicant has two [2] cages of birds on each side of the backyard shed. Pest technician indicated in his report that the birds were messy and throw seeds around, this alone could be attracting the rodents. The technician observed a large hole where the rodents could enter the home. LPA discussed with Applicant that CCL will need a report from the pest control company showing clear findings for all rodents, vermin, and insects before LPA can recommend licensure. Continued on 809C... Continued from 809... Facility is a two story residence with seven [7] bedrooms, four [4] full baths and three [3] half bathrooms. Room #3 downstairs will be dedicated as a staff room, in which the staff will live. The downstairs bedroom located next to the garage, room #1 will be the only double occupancy bedroom at the facility. Room #1 has cracked wood piece extending across the width of the left hand portion of the top of the shower. Dead insects were present on window sill and stuck to the blinds. The upstairs consists of one of the seven total bedrooms and one of the full bathrooms. The upstairs will be the dedicated living space for the applicant and spouse. The facility has a kitchen, dining room, and living room as common areas. All resident rooms are furnished per regulation with a bed, lamp, and bedside table. All resident rooms need a chest of drawers added to be in compliance with regulation. Room #4 and #5 need a chair to be in compliance with regulation. Extra linens and bedding observed. LPA advised trash bins need tight fitting covers. Room #6 has one tile missing at the bottom of each side of the shower, leaving wood open and exposed. Garage houses storage, laundry and emergency supply of water. All room doors leading to the outside have functioning alarms, including the kitchen and front door. Bathrooms have required mats and grab bars. Water temperatures read at: 112 degrees F in kitchen, 112 degrees F in Room #1, 107 degrees F in main bath, 106 degrees F in room #2, 109 degrees F in room #4, 107 degrees F in room #5, 112 degrees F in room #6, all which are within regulation of 105 & 120 degrees F. Facility has large outside area for residents to enjoy. However, fence on east side is in disrepair and is a safety hazard. Boards have green film present along bottom of many boards. Boards show indication of weathering, nails are exposed and protruding, and portions of fence are missing. Fence is leaning heavily in areas. The ramp that extends down the west side of the facility, bordering rooms #2.#4. and #5 has sharp end of screws exposed along top and bottom borders, this also poses a safety hazard. Ramp must be repaired so that sharp ends of screws are not exposed. In the front yard of the house along the east side of the property there are wood pieces have have exposed nails, wood pieces to be removed. In back and front corners of east side fence there are piles of discarded items such as push lawn mower, piles of wood, various gardening supplies, bed frame, box spring, dresser and dresser drawers, painting supplies, ladders and step stools, all items in the corners of fence need to be free from discarded items, they must be safe, sanitary and in good repair. Continued on 809C(2)... Continues from 809C... Smoke and carbon monoxide detectors present and functioning. Two [2] fire extinguishers present and last serviced on 12/8/2023. First aid kit present with all required items. LPA observed all required postings and posters present. Night lights in hallway present. Items required to be repaired/addressed before licensure: Fence on east perimeter Ramp on west perimeter Kitchen cabinet and shelf liners with film present Tile above cutting board on left hand side of range Drawers on both side of range need a functional lock Screen on kitchen screen door Piles of discarded items in front and back corners of east perimeter fence Report from the pest control company showing clear findings for all rodents, vermin, and insects All resident rooms need a chest of drawers Room #4 and #5 need a chair Room #6 one tile missing at the bottom of each side of the shower Room #1 cracked wood piece extending across the width of the left hand portion of the top of the shower. Room #1 dead insects present on window sill and stuck to the blinds. Trash bins need tight fitting covers Extension cords on west corner of facility Vent in hallway on ceiling dust cleaned out Applicant to notify CCL once all repairs complete. LPA will then return to inspect repairs before recommending applicant for licensure. Comp III will be reviewed upon LPA return visit. Exit interview conducted with Applicant and a copy of this report given.the state’s words, verbatim · CDSS document, Apr 30, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: GEOCADIN, DANILO - Applicant/Administrator; GEOCADIN, BERNADETH - Applicant Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 03/14/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. 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, Mar 14, 2024