VALLEY VISTA SENIOR LIVING

Official classification

Type B

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

(f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident...with those activities of daily living such as dressing, eating, bathing... This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited as Resident #1 (R1)'s agreed upon increased need for assistance with activities of daily living following their surgery was not provided which posed a potential health and safety risk to persons in care.

Official plan of correction

ED Mayes conducted a mandatory meeting and in-service training for all medication technicians and caregivers on 12/01/2025 regarding staff responsibilities to ensure residents’ care needs were properly addressed. ED Mnoyan stated that an in-service training will be conducted to review proper notification of care plan changes for residents. ED will submit proof to CCLD by the due date.

Deadline recorded: May 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(28)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1.... residents...shall have all of the following personal rights: (28) To request, refuse, or discontinue a service. This requirement is not met as evidenced by: Based on interview, the licensee did not comply as Resident #1 (R1)'s refusal requests were not being followed on multiple occasions which poses a potential personal rights risk to persons in care.

Official plan of correction

ED Mnoyan stated that an in-service for personal rights will be conducted with all staff and will provide proof to CCLD by the due date.

Deadline recorded: May 14, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in resident medication records were not maintained which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2026 Plan of Correction The Licensee will conduct a medication audit with a consultant, provide staff training, and provide CCLD proof of the consultation confirmation and training date(s).

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in first aid was not maintained for 1 staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/28/2026 Plan of Correction The staff obtained their certification on 04/24/2026. POC cleared.

Official classification

Type B

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in PRN medications were not documented accurately which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2026 Plan of Correction The Licensee will conduct a medication audit with a consultant, provide staff training, and provide CCLD proof of the consultation confirmation and training date(s).

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in resident records were not completed with signatures which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2026 Plan of Correction The Licensee will review resident records, obtain signatures, and provide proof to CCLD by POC due date

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department or..This requirement was not met as evidenced by: Antonio Aguilar(Hired 3/2/26) does not have evidence of a criminal record clearance and is present and working at the facility.

Official plan of correction

Licensee will ensure that all staff, volunteers and any persons who are required to have a criminal record clearance prior to being present at the facility. Licensee will submit a plan of action to the Department as to how they will come into compliance prior to having any staff present at the facility or associate Antonio Aguilar via Guardian if he has obtained a criminal record clearance or a criminal record exemption and submit evidence that the deficiency has been corrected by 4/22/26.

Deadline recorded: Apr 22, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department or..This requirement was not met as evidenced by: Antonio Aguilar(Hired 3/2/26), Erica Arredondo Vasquez(2/9/26) and Maria Ramirez Torres(2/20/26) do not have evidence of a criminal record clearance and are working at the facility.

Official plan of correction

Licensee will ensure that all staff, volunteers and any persons who are required to have a criminal record clearance prior to being present at the facility. Licensee will submit a plan of action to the Department as to how they will come into compliance prior to having the 3 staff present at the facility or associate the 3 staff via Guardian if they have obtained criminal record clearances by 3/10/26 and submit evidence that the association was completed by 3/10/26.

Deadline recorded: Mar 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(A-B)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services:The following provisions shall apply-Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. A bed for each resident, except that married couples may be provided with one appropriate sized bed. B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. A bed and a dresser was not provided for Resident #1's use

Official plan of correction

The Licensee will ensure that a resident is provided with a bed, chair, lamp, night stand and a closet if they are unable or choose not to provide them. Licensee will review Title 22 Section 87307 - Personal Accommodations and Services and submit a written statement that the section was read, understood and will be adhered to at all times by 7/7/25.

Deadline recorded: Jul 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(D)

Regulation authority

CCR

What the official deficiency says

Personal Accommodations and Services:The following provisions shall apply-Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident....if the resident is unable or chooses not to provide them, the licensee shall assure provision of D) Hygiene items of general use such as soap and toilet paper.

Official plan of correction

The licensee will review and update the Admission Agreement to include provisions of personal hygiene supplies if the resident is unable to or chooses not to provide personal hygiene supplies and how the facility will make available hygiene items available for the residents' residents. use. Licensee will also educate the staff so that they are aware that hygiene products wll be provided by the facility if the resident chooses not to provide them. Provide a copy of the revised Admission Agreement related to Personal Hygiene by 7/7/25

Deadline recorded: Jul 7, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents’ needs. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above per interviews conducted, it revealed there are times when only one caregiver is on duty in the Assisted Living side of the operation with 46 residents. This poses a potential health and safety risk for residents in care.

Official plan of correction

The Licensee will review the needs of all the residents to ensure that the current staffing meets the needs of the residents and submit a written plan that will be implemented when staff call out to ensure that there is always staff coverage at all times by 12/16/24

Deadline recorded: Dec 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.686(a)(4)

Regulation authority

HSC

What the official deficiency says

1569.686 A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days...(1) A notice of default...This requirement is not met as evidenced by: Based on interview, licensee failed to ensure The Department, LTCO, residents and their responsible parties were notified of the default received by licensee on 02/16/204, which caused an immediate health and safety risk to residents in care.

Official plan of correction

Licensee stated they will inform the LTCO, residents, and their responsible parties of the notice of default by 03/01/2024. Civil penalty is assessed for violation of this section [Health and Safety code 1569.686(c)]

Deadline recorded: Mar 1, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above as in seven (7) residents centrally stored medications and destruction record (CSMDR) were not properly documented which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/27/2024 Plan of Correction The Executive Director will send a date for staff training regarding medication and submit documentation to CCL.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211(a)(2) Reporting Requirements (2) Occurrences, such as epidemic outbreaks.. which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement is not met as evidence by: Based on interviews, the licensee did not comply with the section cited above, as the facility failed to report eight (8) staff and nineteen (19) residents positive for COVID to the licensing agency, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to do the following: 1.Submit a Statement of Understanding, indicating how the facility will maintain compliance with Section 87211(a)(2). Submit Statement no later than 2/11/2022

Deadline recorded: Feb 11, 2022. A deadline is not proof that correction was completed.