Clark's Villa

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Dina Clark. LPA toured the facility inside and out with ADM. License, Administrator Certificate, and personal rights posters were observed in the facility. 4 residents and 2 staff were observed in the facility. LPA reviewed 3 resident file and 3 staff files. Living room, family room, kitchen, dining room, 2 restrooms, and garage were inspected. 4 resident bedrooms were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet were observed locked. Dish washing solution bottle was observed on the kitchen sink counter, ADM locked it immediately. Room temperature was at 75 degree F, and hot water temperature was at 110 degree F in facility. The temperature of the refrigerator was at 40 degree F, and the temperature of the freezer was at 0 degree F. Fire extinguisher was serviced on 09/30/2025. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Carbon monoxide detectors were tested by ADM, and were working. First aid box, night lights, and flash lights were observed in the facility. Front yard and backyard were inspected. There was no obstruction to block the walkways. The last time the facility conducted the emergency and fire drill was on 01/01/2026. No citation noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.

Licensing Program Analyst (LPA) Christine (Dolores) Kabariti arrived unannounced to conduct the facility's annual required 1 year inspection. LPA met with Administrator, Dina Clark. During visit, LPA toured the facility with staff to include the dining room, living room, kitchen, garage, resident bedrooms, bathrooms, and backyard. All fire exit routes were free and clear of obstruction. All staff are fingerprint cleared and associated to the facility. The facility's temperature was maintained at 72 degrees Fahrenheit. Resident bedrooms observed with beds, linens, night stands, dressers, and adequate lighting. Bathrooms observed with hygiene products and paper supplies. Hot water temperature maintained at 109 degrees Fahrenheit. Facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator temperature maintained at 26 degrees Fahrenheit. Freezer temperature maintained at below 0 degrees Fahrenheit. Sharp objects observed locked. Chemicals and disinfectants observed locked in the garage. Fire extinguisher last services on 10/07/2024. Carbon monoxide detector observed present and operable. LPA reviewed 3 resident files. 3 out of 3 files contained an admission agreement, medical assessment, TB result, personal rights, consent forms, and appraisal/needs and services plan. LPA advised ADM to ensure the safeguard of personal property and valuables form are filled out, even if resident and/or their authorized representative declines to safeguard any items. ADM stated understanding. LPA reviewed centrally stored medications and centrally stored medication records to be maintained. See LIC809-C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA reviewed 3 staff files. 3 out of 3 staff are fingerprint cleared and associated to the facility. 3 out of 3 staff files contained a health screening, TB result, and training records. Staff are provided training to include emergency preparedness, dementia/Alzheimer's, medications, oxygen use, postural support. and hospice services. Facility has an infection control plan. LPA observed PPE supplies located in the garage. Facility has an emergency disaster plan. Emergency drills are being completed quarterly, with the last drill completed in 01/03/2025. Facility has an emergency bin located in the garage. LPA observed a supply of flashlights and batteries. ADM mailed requested documents to update the facility's file to the Department on 01/17/2025. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Dina Clark and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual required 1 year inspection. LPA met with Administrator, Dina Clark. During visit, LPA toured the facility with staff to include the dining room, living room, kitchen, garage, resident bedrooms, bathrooms, and backyard. All fire exit routes were free and clear of obstruction. All staff are fingerprint cleared and associated to the facility. The facility's temperature was maintained at 71 degrees Fahrenheit. Resident bedrooms observed with beds, linens, night stands, dressers, and adequate lighting. Bathrooms observed with hygiene products and paper supplies. Hot water temperature maintained at 106 degrees Fahrenheit. Kitchen observed with a sample menu posted on the fridge. Facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator temperature maintained at 40 degrees Fahrenheit. Freezer temperature maintained at below 0 degrees Fahrenheit. Sharp objects observed locked. Chemicals and disinfectants observed locked in the garage. Fire extinguisher last services on 10/27/2023. LPA reviewed 3 resident files. 3 out of 3 files contained an admission agreement, medical assessment, TB result, personal rights, consent forms, and pre-appraisal. LPA observed 3 out of 3 resident's appraisal needs and services plans were updated on 01/10/2024 and are pending signatures from the resident's authorized representatives. ADM was advised. LPA reviewed centrally stored medications and centrally stored medication records to be maintained. SEE LIC809-C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA reviewed 3 staff files. 3 out of 3 staff files contained a health screening, TB result, employee rights, and training records. Staff are provided training to include emergency preparedness, dementia/Alzheimer's, medications, and oxygen use. Facility has an infection control plan. Facility has an emergency disaster plan. LPA did not observe the facility's disaster drills were being conducted quarterly. ADM was unaware disaster drills were required to be completed quarterly. LPA advised ADM. Facility has an emergency bin located in the garage. LPA observed a supply of flashlights and batteries. Posters observed at the entrance to include but not limited to complaint poster, ombudsman poster, facility license, facility sketch, personal rights, and COVID-19 related resources. LPA interviewed 2 staff and 3 residents. LPA obtained the facility's personnel report. LPA requested for the liability certification by 01/26/2024. No deficiencies were cited per California Code of Regulations, Title 22. Advisory note provided. This report was reviewed with Administrator, Dina Clark and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection focusing on infection control. LPA met with Licensee, Dina Clark. During visit, LPA toured the facility to include the living room, dining room, kitchen, resident rooms, bathrooms, backyard, and garage. Facility's temperature maintained at 73 degrees Fahrenheit. LPA observed the facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. The facility has a cooler filled with emergency supplies located in the garage. Staff present are fingerprint cleared and associated to the facility. Facility has a designated entry point for symptom screening, temperature check, and sign in for all visitors. Face mask required sign posted at the entry. Hand sanitizer, face masks, and gloves made available at the entry. Bathroom supplied with hand washing sign, paper supplies, and hygiene products. Facility staff clean and disinfect multiple times daily and as needed. LPA observed facility's Personal Protective Equipment (PPE) supplies. Facility staff were provided training on infection control and the Licensee plans to renew their annual training, ASAP. LPA reviewed the facility's policies and procedures to visitation, testing for COVID-19, and isolation. The following posters observed to include but not limited to social distancing and cough etiquette. LPA observed the sliding door in the master bedroom to be blocked by a resident's night-stand and the exterior to be blocked by a medium sized table. Licensee immediately moved both items that were blocking the exit area. See LIC9102 for additional information. The following documents were requested by Monday 1/30/2023: LIC610D and LIC500. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with License, Dina Clark and a copy of the report was provided.