Bayview Villa

On 4/16/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to complete the Annual 1-year required inspection started on 4/4/2025. Due to a computer issue, the CARE tool used for the inspection could not be opened until the inspection on 4/16/2025. LPA Calandra was greeted by Thida Khan, Administrator and explained the purpose of the visit. LPA toured the physical plant. Specifically rooms 2048, 2050, 2062, 2064, 2057, and 2059 were entered. No accessible bodies of water or hazards were observed. LPA reviewed 5 resident files. All were observed to be complete. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA received the following documents at the facility: - Proof of Liability Insurance -Emergency Disaster Plan LPA requested the facility send the following documents to the Department by 4/25/2025: -Administrator's Certificate for Violet Loncar The facility does not maintain Personal and Incidental (P&I) monies for residents. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Thida Khan, Administrator and a copy of the report left at the facility.

On 4/4/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Khin Thida, Assistant Administrator/Manager and explained the purpose of the visit. Violet Loncar, Administrator/Licensee arrived later during the visit. LPA Calandra toured the physical plant. This is a 2-story building with 40 bedrooms and 40 bathrooms, a kitchen, terrace, dining room, courtyard, lobby, and garage. All bedrooms had the required furniture and sufficient lighting. The facility's bathrooms had the required anti-skid floor mats and shower bars. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. The facility's first aid kit was observed to have all required items. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. The facility's fire extinguishers were last serviced on 04/11/2024. LPA reviewed 6 staff files. All were observed to be complete. All sharp objects, soap, detergent, and poisons, were observed to be locked and in-accessible to persons in care. The Annual inspection will be completed at a later date. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Khin Thida, Assistant Administrator/Manager and a copy of the report left at the facility.

On 06/10/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required - 1 year inspection visit. LPA met with designated responsible staff person Khin Thida and explained purpose of today's visit. LPA was allowed entry into the facility. This is a two level facility. Annual Fees are current. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility kitchen located on the lower level (Garden level) which is clean and observed appliances are in good repair. Knives are stored in the kitchen behind locked doors. The garden level/lower level is vacant so food is prepared and brought up to the dining room on the upper level. Perishable and non-perishable food items are observed as in place. There are multiple refrigerators and freezers in the garage areas which also carry additional food supplies. LPA observed the medications as in place and locked in a storage cabinet in a locked staff area behind locked doors. There are multiple first aid kits observed as complete with required items through out the facility. LPA observed that the facility is equipped with full sprinkler system, fire extinguishers are placed through out the facility last inspected on 04/11/2024, smoke detector/carbon monoxide detectors are observed in place through out the facility, and central heating/cooling system. Fire panel is observed as last serviced on 03/30/2023 which is located at the rear wall of the front reception desk. Facility is also equipped with fire pull alarms through out the facility. PPE and additional food supplies are observed as in place. Laundry area is also observed as fully operational located in the garage area. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Water temperature was measured at 110F in a vacant resident bathroom adjacent to the front desk area. LPA observed two resident rooms at random and both rooms appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Multiple resident bathrooms are observed as clean and in good working condition. Non-skid flooring is in place in showers and tubs. Disaster drills take place monthly per records observed. Last taking place on 06/02/2024. Resident linen supplies are observed as in place on the second floor of the facility. Continued on next page... 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 Page 2 All files are current per review made. P&I is not handled by the facility. Administrator certificate is observed as expired as of 01/20/2023 but still has not received the updated administrator certificate to this date. Documentation is observed that renewal was sent and paid for via check, and was cashed, on time but the certificate has not been received. Annual fees are discussed with Khin. The following updated item is to be sent to the department by 06/17/2024: • Copy of control of property such as lease agreement or deed No citations issued. Report is reviewed with administrator. Copy is provided.

On 12/16/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA met with Supervising Medication Technician (SMT), Danilo Rubios and explained the purpose of the visit. LPA asked that SMT Rubios call the Facility Designated Representative (FDR), Khin Thida and Licensee and Administrator (AD), Violet Loncar to inform them that CCL was present at this time. Shortly after, LPA met with FDA and explained the purpose of the visit. This facility is licensed to serve 47 residents who are 60 and over all of which may be non-ambulatory. This facility has a dementia plan on file and has a hospice waiver for 8. Current census was 15. It was learned that of the 15 residents, 5 are residing in assisted living and 6 are fresiding in memory care. There are currently 2 residents on hospice and 3 residents receiving home health services. LPA reviewed 6 resident files. LPA reviewed 3 staff files. The Facility Designated Administrator current holds an active administrator certificate #6004504740 and expires on 1/20/2025. The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Reliable Fire Company and is valid until 04/12/2024. The kitchen area was toured. LPA observed a non-perishable and perishable foods in the cabinets and refrigerator. Additional perishable food supplies were identified in the garage. LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time 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 Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. A tour of the garage was conducted. Additional perishable food supplies were identified. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL -LIC 308 -LIC 400 -LIC 500 -LIC 610 -Liability Insurance As a result of this visit, no deficiencies were observed or cited during this annual visit. An exit interview was conducted and copy of the 809 and 809-C was provided to the facility at the end of this visit.