Willowview Home Two

Type of visit: Required - 1 Year

On 4/25/2026 at approximately 10:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. The Administrator, Emalyn Anguiano arrived shortly after to assist with today’s visit. Per the Administrator the facility is currently in the process of undergoing a Change of Ownership. LPA’s record review of Community Care Licensing Division’s (CCLD) FAS database revealed a pre-license facility (ELLA'S PARADISE- Facility # 197610876). Record review confirmed it to be the same address with the latest updates to the Pre-licensing application process to be 4/15/2026. Pre-licensing fire clearance approved for five (5) non-ambulatory residents and one (1) bedridden resident. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 12:30 PM and the following was noted: The facility is a single-story building with four (4) bedrooms and two (2) bathrooms. The facility is currently occupying five (5) residents. There is no designated staff room. Hospice waiver approved for six (6). Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 68°F. LPA observed a fire extinguisher to be located near the kitchen and dated 09/10/2025. LPA observed required postings such as Emergency Disaster Plan and Personal Rights to be located alongside the entrance. A working telephone was observed. (continue to LIC 809-C) Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. Kitchen appliances were observed to be working and in proper condition. Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed to be stored in cabinets located within the hallway’s passageway. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Backyard: LPA observed there to be a locked shed. There is no body of water located at the facility. Garage: There is no garage within the premises. Laundry Room: The laundry appliances were observed to be located outside. LPA observed cleaning solutions and toxins to be located outside stored appropriately within a locked storage unit and inaccessible to residents. The laundry appliances were observed to be working and in proper condition. Medications: The medications along with staff and residents’ files were observed to be kept in a locked storage closet located near the dining room. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Staff records: LPA conducted a complete file review of two (2) staff records. Staff records appeared to be complete and updated. There were no immediate health and safety hazards observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Apr 25, 2026

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff handled resident in care in a rough manner.

On 12/11/2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced initial complaint visit to the facility to investigate the above allegation(s). LPA was greeted by the caregiver and stated the reason for their visit. The Administrator, Emalyn Anguiano was not present, nor could they attend today’s visit. When LPA spoke to the Administrator, they stated they are more than an hour away and designated the caregiver to sign today’s report. To investigate the allegation(s) at 09:35 AM, LPA requested census, resident, and staff roster. At 09:45 AM LPA conducted a physical plant tour, to ensure the health and safety of the residents. At approximately 10:30 AM, LPA requested pertinent documentation related to the investigation. Between 10:30 AM – 1:00 PM, LPA attempted interviews with three (3) residents (R1-R3) and two (2) staff members (S1-S2). (Continue to LIC 9099-C) Unsubstantiated Regarding the allegation: Staff handled resident in care in a rough manner. It was alleged that S2 had handled R1 in a rough manner such as slamming them onto their bed. To investigate the allegation, LPA attempted interviews with three (3) residents and two (2) staff members. R1 is currently not present at the facility. Per S2, R1 was sent to the hospital due to shortness of breath (SOB). LPA was able to interview R1 ahead of today’s visit where R1 revealed that S2 would pick them up from their bed and slam them back down onto the bed. LPA’s interview with R2 revealed that S2 has never slammed them onto their bed. R2 stated S2 is, “Very nice”. LPA attempted to interview R3 but due to their inability to validate the questions being asked due to their medical diagnosis, LPA terminated the interview. LPA’s interview with S2 revealed that they never treated R1 in a rough manner such as slamming them. S2 denied treating any of the residents in a rough manner or slamming them onto their bed. S1 was not present during the time of the visit but LPA was able to speak to them over the phone where they stated S2 is the main caregiver and the established designee of the facility. During LPA’s physical plant tour, LPA observed S2 to be the only staff member present to care for the two (2) residents. LPA observed S2 to be cleaning and cooking. LPA observed S2 preparing lunch for both residents. LPA observed both residents to be in good condition and did not observe any of them to appear in distress. LPA observed both R2 and R3 interacting with S2. LPA observed both residents to not show any signs of distress when around S2 such as flinching, withdrawal and/or panicking. Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. During LPA’s physical plant tour and record review. LPA observed deficiencies which will be addressed on a Case Management visit. Exit interview conducted and a copy of this report was provided to the caregiver.the state’s words, verbatim · CDSS document, Dec 11, 2025 · control 31-AS-20251202141313

Type of visit: Case Management - Other

On 12/11/2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted a Case Management visit during their initial complaint visit (Control# 31-AS-20251202141313) and the following deficiencies were observed. LPA interviewed and conducted record reviews pertaining to three (3) residents (R1-R3) and one (1) staff member (S2). Upon LPA’s record review, LPA observed three (3) of the three (3) residents records to be incomplete and not updated. LPA observed three (3) of the three (3) residents to be missing their Needs and Services and Pre-Appraisals. When LPA interviewed S2 and questioned how they are providing care to the residents without knowing what their care plan or needs are, S2 stated that they will review their hospital discharge paperwork and base their care from there forth. During LPA’s record review of S2’s personnel record, LPA observed S2 First-Aid/Cardiopulmonary Resuscitation (CPR) certificate to be dated 10/12/2022 which was expired. LPA advised S2 to renew their certificate, which they agreed they would do so. LPA could also not locate any training for S2. S2 stated that they are to receive training from the Administrator. Let it be noted that S2 was the only caregiver present during LPA’s visit. (Continue to 809-C) During LPA’s physical plant tour, LPA observed the exit leading to the front of the facility from the backyard to be broken. LPA observed two brown squared nightstand dressers pushed up against an unsecured small white gate being utilized as a form of barrier from the exit to the front driveway. LPA also observed the front fence to be broken with one gate attachment missing. LPA observed an unsecured white small gate and mattresses with a toilet placed in front being used as the replacement of said missing gate. Citations issued. Please refer to 809-D. No other immediate health and safety issues observed during the time of visit. Exit interview conducted, appeal rights given and a copy of this report was provided to the caregiver.the state’s words, verbatim · CDSS document, Dec 11, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Dec 25, 2025

87457 Pre-Admission Appraisal. (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs... This requirement is not met as evidenced by: Based on interviews, record review and observation three of the three residents records were incomplete and not updated: missing their Pre-Appraisal and completed Needs/Services Plan which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: The Administrator will review the regulation and email LPA Segovia a statement of understanding. Additionally, the Administrator will email LPA Segovia the Pre-Appraisals and Needs/Services for all three residents.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.618(c)(3) · Plan of correction due date: Dec 15, 2025

(c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met evidenced by: Based on interviews, record review and observation S2 was missing their current First-Aid/CPR training certificate and was the only staff present which poses a potential Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: The Administrator will email LPA Segovia S2's updated first-aid/CPR training certificate

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c)(1)(A) · Plan of correction due date: Dec 25, 2025

87412 Personnel Records. (c) Licensees shall maintain in the personnel records...(1) The following staff training...shall be documented: (A) For staff...there shall be documentation of... initial training...and annually...This requirement is not met as evidenced by Based on interviews, record review and observations S2 was missing their intital training and annual training which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: The Administrator will email LPA Segovia S2's initial training and current annual training.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Dec 25, 2025

87303 Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include...the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observations two gates of the facility are broken which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: The Administrator will email LPA Segovia proof of photos showcasing both gates to be fixed and in good repair.

Allegation investigated: Staff yells at resident.

On 11/05/25 at 01:20 pm, Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced 10-day complaint visit to the facility to investigate the above allegation. LPA was greeted and granted access to the facility by staff. LPA spoke with Administrator Emalyn Anguiano and explained the reason for the visit. Administrator stated that the facility has been sold to Ellis Paradise but had no exact date to provide. LPA explained that until there is a change of ownership the facility still falls under the current Licensee and Administrator. Administrator was reluctant but accepted that responsibility is still under Willowview Home Two LLC and that she is the current Administrator. Administrator stated that they would not be able to join LPA since they were an hour away taking care of a previously made appointment. Administrator designated staff Elbert Perez to assist LPA and sign the report. Entrance interview conducted. Continued on LIC9099-C Substantiated At approximately 01:45 pm, LPA requested copies of resident and staff rosters, liability insurance and Administrator Certificate. LPA also requested copies any documents relevant to the investigation. At 02:00 pm, LPA conducted a physical plant tour to ensure the health and safety of the residents are protected. At approximately 2:30 pm LPA conducted a file review of documents provided. Between 01:30 pm and 03:30 pm, LPA conducted interviews with one (1) staff, and three (3) out of three (3) residents. Allegation: Staff yells at resident. It is reported that staff yells at resident. Regarding this allegation it is reported that resident #1 (R1) is constantly yelled at by a staff member. LPA interviewed R1 and R1 stated that the current staff member is not the one that has yelled at R1. R1 revealed that a different staff member that is no longer working at the facility was the one that had previously yelled at R1. Interview with Resident #2 (R2) revealed that staff do not yell at them. Interview with Resident #3 (R3) revealed that staff sometimes yell but R3 also stated that they are hard of hearing and that’s why staff yell. Interview with Staff #1 (S1) present at the facility revealed that they have not witnessed any other staff yell at the residents, but did acknowledge that there has been another staff member in their place when S1 took a day off, therefore they did not witness any yelling. S1 was not able to provide any information regarding the staff member in question as there is no facility file on them. LPA contacted Administrator over the phone and inquired about additional staff at the facility and Administrator revealed Staff #2 (S2)’s identity. LPA was not able to locate S2 on the Guardian website and explained that all staff need to be fingerprint cleared and associated to the facility prior to working and providing direct care and supervision to residents. This will be addressed in a case management. Based on interviews, observations and file reviews this allegation is deemed substantiated. Citation issued. Exit interview conducted and a copy of the report provided to designee.the state’s words, verbatim · CDSS document, Nov 5, 2025 · control 31-AS-20251030092102

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Nov 17, 2025

Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above by permitting Staff #2 (S2) to yell at residents, which posed a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator discussed and agreed to Personal Rights training for all staff and will submit proof of training with attendance roster to LPA via email by POC due date.

Type of visit: Case Management - Deficiencies

On 11/05/25 Licensing Program Analyst (LPA) Lorena Casillas met with staff member Elbert Perez for a case management visit. The purpose of the case management visit is to address deficiencies observed during the course of investigation for complaint # 31-AS-20251030092102. The deficiencies were not alleged but are related to the complaint. Administrator was not able to meet with LPA and assigned staff member Elbert Perez to sign the report. During the facility file review LPA was not able to locate a facility file for Staff #1 (S1). LPA searched the Guardian website to verify the facility roster and could not locate S1 on the Guardian website. Due to no facility file on S1, LPA was not able to search and check if S1 has a current fingerprint clearance. Interview with Staff #2 stated that S1 covered for them on 10/31/25, however interview with Resident #1 (R1) revealed that S1 had been at the facility for about a month. LPA expressed to Administrator the importance of making sure that staff is fingerprint cleared and associated to the facility prior to working and providing direct care and supervision. A civil penalty will be issued. Administrator was also advised that all staff have to have a facility file and it needs to be readily available for review. A citation will also be issued for not having a file for S1. Citations issued. Exit interview conducted. Copy of report provided to designee.the state’s words, verbatim · CDSS document, Nov 5, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Nov 6, 2025

Criminal Record Clearance(e)All individuals subject to a criminal record review... Health and Safety Code Section 1569.17(b) shall prior to working... in a licensed facility(2)...California clearance or a criminal record exemption ...This was not met as evidenced by: Based on interviews and record reviews the licensee failed to have a crominal record clearance for S1. This poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator will submit a written letter via email to LPA that going forward they will adhere to the cited regulation. Administrator also agree to not having S1 return to the facility until a clearance and association is obtained.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87412(a)(1)-(13) · Plan of correction due date: Nov 6, 2025

Personnel Records (a)The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: ...(1)-(13)...This was not met as evidenced by: Based on interviews, observations and file review the licensee failed to have a staff file for S1. this poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: Administrator will submit a written letter by the POC due date stating that they will review Title 22 Division 6 Chapter 8 of the CA Code of Regulations 87412 Personnel Records and that going forward will adhere to these regulations. Administrator will also complete a file for S1 by POC due date.

Type of visit: Required - 1 Year

On 1/07/2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. Upon arrival LPA rang the doorbell which Administrator Emalyn Anguiano responded through the video “Ring” doorbell. LPA stated the reason for their visit. The Administrator stated she is not available for today’s visit, and they have zero (0) residents currently. The Facility Representative Kim Vivar arrived shortly after to assist with today’s visit. LPA asked for census and insurance. LPA conducted a physical plant tour at approximately 11:15 AM and the following was noted: There is only one entrance being utilized at the facility. The facility is a single unit building with four (4) bedrooms and two (2) bathrooms currently occupying zero (0) residents. One (1) staff room located in approved conversion of garage. The facility has approved fire clearance for six (6) residents of which four (4) may be ambulatory and two (2) non-ambulatory. Hospice waiver approved for six (6). Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Required postings such as See/Say Something, Long-Term Ombudsman, and Resident’s Rights were located upon entrance. Common areas: Living room and dining room observed to be neat, clean, and organized. Common areas observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 70°F. Fire extinguisher located in the kitchen and dated 03/04/24. Kitchen: Kitchen observed to be clean and inaccessible to pests. Knives and sharps observed to be locked in kitchen drawer inaccessible to residents. Cleaning solutions and toxins observed locked underneath kitchen sink (continued on LIC 809-C) Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water in this facility. Locked storage unit observed. Smoke detectors and carbon monoxide observed to be working properly and were tested. Garage: The garage was converted into a room and is shown on approved facility sketch. It is also being used for staff reception area, extra storage, and staff room. The converted unit can be accessed from inside the facility and kept locked inaccessible to residents. Laundry Room: The laundry room is located inside the converted unit alongside staff room. Bedrooms: The Residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations at 111.0°F. Appropriate grab rails and skid mats were observed and in proper condition. Medications: Medication logs and facility files kept stored in locked closet leading towards the kitchen inaccessible to residents. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer, and manual. Resident records: There are zero (0) residents. Administrator stated both residents were moved to different facilities. There was no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Facility Representative.the state’s words, verbatim · CDSS document, Jan 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Rosebella “Bella” Hugal, and explained the reason for the visit. At approximately 2:45pm, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual, hardwired and interconnected. There are two fire extinguishers. One is located in the kitchen, and the other is located in at the enclosed patio area. The charge date is March 4, 2024. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Cleaning supplies were stored locked underneath the kitchen sink. Bedrooms: There are four (4) bedrooms designated for residents' use. Two (2) bedrooms are shared and two are private. Currently there are two (2) private residents in care. Bedrooms, in use by the residents and the vacant rooms, were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 109 and 114 degrees Fahrenheit. No cleaning supplies were observed in either bathrooms during the day of the inspection. Common Areas: These included the living room and dining area. The living room was furnished with four recliners, two tables and television. The dining room table is large enough to seat up to six (6) individuals. Living room and dining room furniture where in good repair. Floors were mopped and clean. Exits and passageways were clear. Surrounding Grounds: Entry/exits to the front and back yards were free of obstruction. There is an enclosed patio area where activities can be held, and a glass door, which leads to the backyard. There is a storage building in the backyard that stores PPE supplies. The outdoor area was free of hazards. Gates at both sides of the home presents no exterior lock and is clear to exit/evacuate in case of an emergency. Laundry area: The laundry area is located at the corner of the enclosed patio. Toxins and detergents not present at this time. Staff Workstation/Office: There is a staff workstation located at the enclosed patio, adjacent to the laundry area. Resident Files: Resident files are kept locked in the medication closet. LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: Staff files are also kept locked in the medication closet. LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medications are stored in a locked closet by the living room (medication closet). In addition, there is a locked drawer in the kitchen that licensee also stores medications in. Medication and Medication Records were reviewed for proper storage and documentation. Garage: The garage is attached to the building. It was converted into a room, but is also used as storage. Room was already built, and permit was already obtained prior to purchase of the property. Only entry is at the side, which has a locked door and no resident access. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, May 15, 2024