Old Oak Golden Villa, Llc

On 12/4/2025 at 9:30AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Sergio Devera and explained the purpose of the visit. Administrator, Corazon Nunez was unable to be at the facility and designated caregiver to sign licensing reports. LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 6/16/2025. One week of nonperishable and 2-day of perishable food supplies were available. LPA observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. LPA reviewed 4 residents and 3 staff files starting at 10:00AM. LPA reviewed a sample of resident's medications during inspection. At 11:30AM, LPA observed S2 does not have TB test on file. At 12:28PM, LPA measured hot water temperature at 129.2 degrees F in the hallway bathroom. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted with Sergio Devera. A copy of this report and appeal rights was provided.

On 12/4/2024 at 10:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Maribel Zumel and explained the purpose of the visit. Administrator, Corazon Nunez arrived 4 hours later. LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 6/25/2024. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 118.6 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. LPA reviewed 4 residents and 3 staff files starting at 11:30AM. LPA interviewed 2 residents and 2 staff during inspection. LPA reviewed a sample of resident's medications starting at 2:50PM. At 12:00PM, LPA observed two residents (R2 & R3) was identified as bedridden in the physician's reports. Both residents were not on hospice care. LPA was unable to observe the residents reposition independently. Facility does not have a bedridden fire clearance. Civil penalty of $500 is being assessed. At 1:00PM, LPA observed S2 and S3 does not have medication training documents on file. At 2:00PM, LPA observed facility did not complete quarterly disaster drills and last disaster drill documented was on 11/10/2023. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health & Safety Code. Failure to correct deficiencies may result in civil penalties. Exit interview conducted. A copy of this report, civil penalty, and appeal rights was provided.

On 12/12/2023 at 9:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Marietta Bugayong and explained the purpose of the visit. Administrator, Corazon Nunez arrived an hour later. The facility’s fire clearance was approved for 6 non-ambulatory residents of which 4 residents maybe under hospice care. LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 6/29/2023. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 117.1 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. Last fire drill was conducted on 11/10/2023. LPA reviewed 4 resident and 3 staff files starting at 9:50AM. LPA interviewed 2 residents and 2 staff at 12:45PM. LPA reviewed a sample of resident's medications starting at 1:30PM. At 9:30AM, LPA observed dish soap and disinfectant wipes were stored with food supplies. Staff removed those items during inspection. At 10:15AM, LPA observed R1 and R4 does not have TB test results on file during record review. At 10:20AM, LPA observed R2 and R4 does not have current medical assessments on file. (Continue on LIC809C...) 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 At 11:30AM, LPA observed S2 and S3 does not have current First Aid training completed. At 12:00PM, LPA observed S2 and S3 does not have current hospice training on file. At 1:45PM, LPA observed R4 ran out of medication (Senna 8.6mg) and does not have additional bottle available. LPA observed R4 has doctor's order for Senna 8.6mg dated 3/27/2023. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights was provided.

On 12/8/2022 at 2:00PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with caregiver, Nielgar Buton and explained the purpose of the visit. Licensee, Corazon Nunez arrived 40 minutes later. Upon entry, staff did not check LPA's temperature, but later checked LPA's temperature. LPA was asked to fill out visitor's log. LPA observed hand sanitizer at screening station. LPA toured facility including but not bedrooms, bathrooms, kitchen, common areas, garage, and outdoor areas. LPA observed cough etiquette and physical distancing posted in the common areas. All sinks were equipped with soap and paper towel. Hot water was measured at 111.1 degrees F in the hallway bathroom. During record review, LPA observed visitors log and temperature log. LPA observed facility has a copy of Mitigation Plan on file. LPA observed PPE, food, and paper supplies are sufficient. At 2:15PM, LPA observed an unlocked mallet and pizza cutter in the kitchen. Under the sink cabinet that had knives and cleaning supplies were unlocked. LPA observed unlocked vitamins in staff room. Staff locked up mallet, pizza cutter, under the sink cabinet, and supplements during inspection. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency may result in Civil Penalties. Exit interview conducted. A copy of this report and appeal rights provided.