JOHN VILLA'S HOME CARE I

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 which the LPA reviewed the records and the last drill was on April 22, 2026, which was not in the last quarter. poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/10/2026 Plan of Correction The Licensee will send LPA Simerly proof of an updated drill by the POC due date.

Official classification

Type A

Official code

87465(c)(2)

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: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, R4 is not correctly receiving one medication as prescribed by the physician which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2025 Plan of Correction

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the kitchen counter is in process of being replaced and the air conditioner for bedroom 3 has been removed and not replaced which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2025 Plan of Correction AD stated repairs to kitchen and AC replacement will be completed by POC due date. AD to submit photos to LPA as proof.

Official classification

Type B

Official code

1569.695(a)(2)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, there is no emergency water available which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2025 Plan of Correction AD stated he will purchased 30 gallons of water. AD to send photos of water and receipt to LPA by POC due date.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic... This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observations, bedrooms 3 and 4 exits are obstructed by beds which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2025 Plan of Correction AD stated he will rearrange beds to clear exit doors by POC due date. AD to email or text LPA proof.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: LPA observed clutter in the back yard and on both sides of the house leading to the exit gates; 10 huge tires on one side and bags, boxes, tools, ladder, kids toys, fans, 2 propane tanks, 3 oxygen tanks, wheelbarrow, empty plastic bins, and trash cans on the other side and in front of the shed.

Official plan of correction

Licensee to ensure the facility is clean, safe, sanitary and in good repair at all times. Licensee to clear back yard of clutter and clear walkway on both side leading to exits and submit proof of correction to LPA by 01/31/2025.. Since this a second violation within 12 months, an LIC 421 Civil penalty was assessed today in the amount of $250.00 for the repeat violation.

Deadline recorded: Jan 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA also observed clutter on the back yard and on the side of the house leading to the exit gate. LPA observed wheelchairs, walkers, tools, two long pieces of wood and cardboard boxes. LPA observed that the trash cans were blocking the exit to the side gate by the garage.

Official plan of correction

POC Due Date: 08/19/2024 Plan of Correction Licensee to email POC proof to LPA by POC due date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. In the backyard LPA observed cleaning supplies such as lysol, Fabuloso multi-purpose cleaner, Clorox, and a bottle of paint.

Official plan of correction

POC Due Date: 08/19/2024 Plan of Correction Licensee to email POC proof to LPA by POC due date.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed that the sink hot water faucet was off. Per AD the hot water in one of two restrooms was off because the hot water faucet leaks.

Official plan of correction

POC Due Date: 08/23/2024 Plan of Correction Licensee to repair the hot water faucet and email POC to LPA by POC due date.

Official classification

Type B

Official code

80087(a)(1)

Regulation authority

CCR

What the official deficiency says

80087 Building and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview of Administrator Juan Diaz, flies and fruit flies were observed in the facility which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

POC Due Date: 08/26/2022 Plan of Correction Licensee to immediately dispose uneaten food and to purchase addtional fly traps and to sumbit proof of correction to LPA by POC due date.