Buena Vista Manor House

On 1/29/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to a self-reported incident involving two residents and a staff member. LPA Calandra was greeted by Angie Guzman and Hazel Castro, Co-Administrators and explained the purpose of the visit. According to the Administrator, R1 and R2 were sitting together when S1 asked R1 if they would like to go to their room as it was time for R1's medications. S1 reportedly spoke in a non-professional manner to R1 and shoved R2 when R2 was about to follow R1 to go back to their room. According to the Administrator, no injuries were sustained. During the visit LPA collected the following documents: -Facility Roster -Staff schedule Deficiencies are cited under the California Code of Regulations. Failure to correct the deficiencies by the POC due date may result in Civil Penalties. An exit interview was conducted. A copy of this report along with Appeal Rights were provided.

On 12/24/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a case management visit in regards to an elopement that occurred on 12/22/2025. LPA Calandra was greeted by Angie Guzman, Administrator and explained the purpose of the visit. David Wall, Licensee/Co-Administrator arrived later during the visit. According to the Administrators, R1 left the facility on 12/22 in the evening and is known to wander around the facility often. Staff searched the grounds of the facility for the resident but could not find them and contacted the police and responsible party for R1. The resident was found nearby uninjured and transferred to a local hospital to be checked on. No injuries were reported after the hospital visit. Based on record review, the LIC 602: Physician's report says that the resident is not allowed to leave the facility unassisted. In addition, the facility was also experiencing a power outage at the time of the incident. Based on interviews and record review, the Licensee was following their emergency and disaster plan and elopement policy. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representative and a copy provided.

On 10/28/2025, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Executive Director, David Wall. LPA explained the purpose of the visit. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers inspected and charged. Smoke and carbon monoxide detectors and fire safety systems were present and serviced by fire inspection agency. There was a sufficient supply of both perishable and nonperishable foods as required, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished constantly throughout the week and stored properly. Facility provides a variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked closets throughout each floor all of which were secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. There is a large garden area equipped with appropriate shading and two additional outdoor balcony patios for resident use. No Deficiencies cited. Report reviewed and discussed with executive director, a copy of report left at facility.

Lastly, upon review of photo evidence provided of R1, LPA found that there is not a clear indication of any signs of distress or injury or R1 to have fallen. Due to a lack of corroborating evidence the allegation is found to be unsubstantiated. A finding that the complaint allegation lack of supervision resulting resident falling off bed is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiency cited.

On 7/9/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of conducting a case management on a facility reported incident. The facility reported that on 7/6/2025, a resident (R1) had not been observed on the facility grounds and had eloped. R1 was located, returned to the facility within hours and the level of care was increased. LPA found that R1 had recently moved into the facility as of 6/10/2025 and was transitioning to the new level of care and facility. Upon review of R1's records, LPA found that R1 is not able to leave the facility unassisted. Facility had responded to the incident by updating R1's care with 24 hour 1:1 private care services. In addition, it was agreed upon with R1's conservator to utilize an air tag to determine R1's location. LPA found that the facility had responded appropriately to the incident to ensure R1's transition to the facility and prevent any further incidents. During the visit LPA observed R1 out in the facility common areas with their private caregiver and additional staff providing supervision. LPA observed staff redirecting and implementing individualized methods to help with R1's transition and encourage engagement in facility activities and community. No deficiencies cited during today's visit.

On 10/25/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Front Desk Staff, Elizabeth Palle. Executive Director, David Wall and Co-Administrator, Hazel Castro were contacted and arrived later in the visit. The facility currently provides care for 67 residents, 7 of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located on each resident floor, kitchen and common spaces were found to be charged. Smoke and carbon monoxide detectors and fire safety systems were present and serviced by fire inspection agency within the year. Additional inspection is expected to be completed in the following month. There was a sufficient supply of both perishable and nonperishable foods as required, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished constantly throughout the week and stored properly. Facility provides a variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked closets throughout each floor all of which were secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. The facility is equipped with two elevators, one of which is currently under service awaiting additional parts for repair. There is still one elevator that is fully operational for resident use. Residents that were out in the community during the inspection were observed interacting with staff, fellow residents and visitors in the common areas. LPA found that staff and resident engagement is well practiced with activity calendars developed on a monthly basis. Residents are encouraged to participate in activities, well observed during the tour. Residents were also observed to have a positive and personable relationship with staff and Executive Director. There is a large garden area equipped with appropriate shading and two additional outdoor balcony patios for resident use. Continued onto 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 conducted a sample file review for residents and 4 out of 5 residents require updated appraisals. Technical Violations issued. Upon a spot check of staff files, LPA found that caregiver staff have current 1st aid and CPR and annual training completed. Lastly, A spot check of medications was conducted and found that all medication counts and records to be in order. Angelina Guzman's Administrator Certificate is currently active through 7/17/2025. LPA requested the following documents be sent to CCL by COB 11/8/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Liability Insurance No deficiencies cited during today's visit.

On 6/20/2023, Licensing Program Analysts (LPA) Murial Han conducted an unannounced Case Management - Legal/Non-compliance visit. LPA completed the passive COVID-19 screening at the front desk. LPA met with Administrators, Hazel Castro, Angelina Guzman and, co-administrator David Wall. LPA explained the purpose of the visit. During today's visit, LPA review staff training records in the areas of Observation and Assessment of Residents, Residents' Personal Rights, Reporting Requirements, Types and Symptoms of Infectious Diseases, and Prevention/Mitigation and Care of Residents with Infectious Diseases and LPA observed records to be sufficient. During the facility tour, LPA observed COVID-19 signs are posted by the main entrance and around the facility. Facility appeared to be cleaned and tidy. Residents in the living room mingling with each other. Activity room was set up for an activity. Multiple hand sanitizing stations are observed. Kitchen storage room appeared to be cleaned, and tidy. The walking refrigerator temperature was observed to be at 39 degrees Fahrenheit (F) and freezer was at -0 degrees Fahrenheit(F). Fire extinguisher was last serviced on Nov 21, 2022. PPE supply is adequate. A comfortable temperature is maintained, lighting is sufficient for comfort and safety. No deficiency cited today. This report is reviewed and discussed with Administrator. A copy is provided.

On 2/15/2023 Licensing Program Analysts (LPA) Murial Han conducted an unannounced Case Management - Legal/Non-compliance visit. LPA was properly screened by the receptionist. LPA met with Administrators, Angelina Guzman, co-administrator David Wall and Infection Control Preventionist Diana Wall.. During the facility tour, LPA observed COVID-19 signs are posted by the main entrance and round the facility. LPA observed residents in the activity room were wearing face mask and practicing social distancing. Multiple hand sanitizing stations are observed as in place. The tables and chairs in the dining room and activity room remain 6" apart. Kitchen appeared to be cleaned, and tidy. The refrigerator temperature observed to be at 38 degrees Fahrenheit and freezer was at -4 degrees Fahrenheit. Hand-washing instruction is posted by the kitchen sink. The public bathrooms are equipped with liquid soaps, paper towel, trash cans with lids and hand washing instruction posters. The water fountains are taped off with a sign stating "Do Not Use". LPA observed individual infection control stations were set-up in the hallway through-out the facility. LPA reviewed infection control training records, and daily COVID-19 screening records for visitors, staff and residents. No deficiency cited today. This report is reviewed and discussed with the Administrator. A copy is provided.

On 12/21/22, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was properly screened by the receptionist at front entrance with the COVID-19 questionnaire and the temperature taken. After the screening, LPA was greeted by the Administrator, Angelina Guzman, Infection Control Preventionist, Diana Wall and Co-Administrator, David Wall. LPA explained the purpose of the visit. LPA reviewed the following documents: daily monitoring and screening for residents and staff (residents are screened daily unless they tested positive for COVID-19 then they will be monitored every 4 hours; staff are being screened at the beginning and the end of their shifts). LPA observed PPE/ COVID-19 training is completed on a monthly basis. Staff provided a tour of the facility. LPA observed COVID-19 signs are posted by the main entrance, there are hand sanitizer stations through-out the facility. The public bathrooms for the staff and residents are equipped with liquid soaps, paper towels and hand-washing signs indicating the 20 second rule. In the activity and living rooms, LPAs observed residents were wearing masks, and tables were 6" apart. The water fountains are continued to be taped off with a sign stating "Do Not Use". The dining room observed to be cleaned and the tables were at least 6" apart. The elevator has COVID-19 signs posted both inside and outside and hand sanitizer station is installed next to the elevator. Individual infection control stations were set-up in the hallway through-out the facility. The facility has 2 PPE supply stock rooms- one on the 2nd floor and one on the 3rd floor. The facility is well equipped with supplies. Donning and doffing signs are posted by each room. 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 Medications are stored appropriately and inaccessible to residents, a comfortable temperature is maintained, lighting is sufficient for comfort. First-aid kit is inspected and complete. No deficiency cited today. This report is reviewed and discussed with the Administrator, Co- Administrator and the Infection Control Preventionist. A copy is provided.

On 5/24/2022, Licensing Program Analysts (LPA) Murial Han conducted an unannounced Case Management - Legal/Non-compliance. LPA was properly screened by the receptionist. LPA met with Administrators, Angelina Guzman, and Hazel Castro. During the facility tour, LPA observed COVID-19 signs are posted by the main entrance, the lobby, the dining room, the hallways on each floor, the staff break room, etc. Multiple hand sanitizing stations are observed as in place. Residents in the dining room are 6" apart from each other with face covering. The tables and chairs in the dining room and activity room are at least 6" apart. The public bathrooms are equipped with liquid soaps, paper towel, trash cans with lids and hand washing instruction posters. The water fountains were taped off with a sign stating "Do Not Use". LPA observed individual infection control stations were set-up in the hallway through-out the facility. The 3rd floor is the designated Red Zone. LPA observed isolation PPE stations set-up both inside and outside of each room equipped with PPE supplies, hand sanitizers, alcohol wipes, thermometers, daily COVID-19 screening logs, donning and doffing signs are posted by each room, the bathrooms are equipped with supplies, and hand-washing signs are posted by the sinks. In addition, there is a designated PPE supply room and a designated staff break room with a bathroom inside on that floor. LPA reviewed infection control training records, and daily COVID-19 screening records for visitors, staff and residents. No deficiency cited today. This report is reviewed and discussed with the Administrator. A copy is provided.

On 12/30/2021, Licensing Program Analysts (LPA) Murial Han conducted an unannounced Case Management - Legal/Non-compliance virtual inspection due to COVID-19. LPA met with Administrator, Angelina Guzman, Administrator, Hazel Castro, Co-Administrator, David Wall and Infection Control Preventionist, Diana Wall LPA was provided a virtual tour by the Infection Control Preventionist, Diana Wall and LPA observed COVID-19 signs were posted by the main entrance, there were several hand sanitizer stands installed and screening logs for the visitors and the facility staff. The public bathrooms were equipped with liquid soaps, paper towel, trash cans with lids and hand washing instruction posters. There were hand wipes and hand sanitizer bottles placed on many of the tables, all the trash cans were observed to have foot operated lids, and the water fountains were taped off with a sign stating "Do Not Use". and individual infection control stations were set-up in the hallway through-out the facility. During the tour on the 3rd floor designated isolation unit, LPA observed isolation PPE stations, and two trash cans with foot operated lids (one for soiled PPE supplies and the other one for soiled incontinent changes and garbage) were set-up before the entrance. After the entrance, LPA observed isolation PPE stations set-up both inside and outside of each isolation room equipped with PPE supplies, hand sanitizers, alcohol wipes, thermometers and daily COVID-19 screening logs, donning and doffing signs were posted both inside and outside of each room, and the bathrooms were equipped with supplies, and hand-washing signs were posted. During today's inspection, LPA also reviewed the facility's Medication Management process and the facility explained the documentation procedure for the resident's files. No deficiency cited today. This report is reviewed and discussed with the Administrators, Co- Administrator and the Infection Control Preventionist. A copy is provided.

On 10/6//2021, Licensing Program Analyst(LPA) Murial Han and LPA Jaime Vado conducted an unannounced annual inspection. LPAs were properly screened by the receptionist at front entrance with the COVID-19 questionnaire and the temperature. After the screening, LPAs were greeted by the Administrator, Angelina Guzman and Co-Administrator, David Wall. LPAs explained the purpose of the visit. LPAs reviewed the following documents: daily monitoring and screening documents for residents and staff (residents are being screened twice a day- AM and PM and staff are being screened as they arrive and when they leave), training records, and COVID-19 testing records and schedule. After reviewing the records, LPAs started with a tour of the facility that was led by the Infection Control Preventionist/Public Health Nurse, Diana Wall along with the Administrators, Angelina Guzman and Hazel Castro and Co- Administrators, David Wall, LPAs observed COVID-19 signs were posted by the main entrance, there were several hand sanitizer stands installed. The public bathrooms for the staff and residents were equipped with liquid soaps, paper towels and hand-washing signs indicating the 20 second rule. LPAs observed residents were wearing masks and maintaining social distancing in the Activity room, the couches and the benches are marked off appropriately to ensure social distancing is maintained. There were hand wipes and hand sanitizer bottles placed on many of the tables, all the trash cans were observed to have foot operated lids, the water fountains were taped off with a sign stating "Do Not Use", the dining room observed to be cleaned and the tables were at least 6" apart. The dining room staff demonstrated the equipment and high touched areas such as the food carts, the tables, the door knobs, etc. that are being sanitized every 4 hrs along with a log showing who and when those cleaning tasks were performed. The elevator has COVID-19 signs posted both inside and outside and hand sanitizer stand was installed next to the elevator. Individual infection control stations were set-up in the hallway through-out the facility. 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 After the tour on the 2nd floor, we continued onto the 3rd floor that the facility has designated it as to be the COVID-19 unit. LPAs observed closed lid trash cans were placed in front of each room, donning and doffing and other COVID-19 signs were posted on both inside and outside of the doors, the bathrooms were equipped with liquid soaps, and hand-washing 20 second signs. LPA recommended to remove the cloth towels in the bathrooms. The facility has 2 PPE supply stock rooms- one on the 2nd floor and one on the 3rd floor. The facility is well equipped with supplies. The staff members who are designated to work in the COVID-19 unit, has their own assigned PPE supplies stocked in a container with their names on it. No deficiency cited today. This report is reviewed and discussed with the the Administrators, Co- Administrator and the Infection Control Preventionist. A copy is provided.

On 10/06/2021 at 1045 Licensing Program Analysts (LPA) Jaime Vado and Murial Han conducted an unannounced case management - Legal/Non-compliance inspection. LPAs met with David Wall and Diana Wall During today's inspection visit LPAs made observations within the facility with both David and Diana. This is a five floor facility. Residents reside through out all floors. Upon entrance to the facility that is considered the second floor. PPE storage room is located on this floor adjacent to front desk area. PPE is in place. COVID check in procedures are in place. LPAs observed seating areas and specific seats are marked to show which are allowed to sit in adhering to the six foot distancing policy. Exterior balcony also observed with similar seating arrangements. Dining room is observed as well with six foot rule in place. Cleaning schedule and procedure was observed as in place. Group activity room is observed on this floor as well as taking place with social distancing being practiced and residents are masked. Multiple hand sanitizing stations are observed as in place. Third floor is observed and COVID isolation area is located on this floor. Seven rooms are designated for COVID positive. Room 3106 is observed as equipped with required CDSS furniture, a private bath, individual PPE, trash cans for doffing and trash cans with tight fitting lids are present. COVID signs encouraging social distancing, hand washing, and masking observed through out entire facility and bathrooms. 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 Case Management - Legal/Non-compliance Records are reviewed for staff and residents. Records reviewed indicate that facility is training staff, new and current, in the the items outlined in the Stipulation Waiver and Order issued in Section 2 part A. Training records show that staff are trained annually in the topics outlined in Section 2 part B. In accordance to Section 2 part C there are co-administrators in place. In accordance to Section 2 part D, LPAs discussed the regular assessment of residents to ensure that facility is appropriate setting for those residents assessed and when necessary to evict the facility understands it will follow proper eviction procedures under Title 22, Code of Regulations, section 87224. Under section 3 part B David Wall agreed to begin the required training outlined in this section during the second year of probation. Report is reviewed with David Wall. No citations issued.

Licensing Program Analyst (LPA) Michael Garcia, Licensing Program Manager (LPM) Julio Montes, and Regional Manager (RM) Vivien Helbling conducted a collaborative tele-visit meeting with facility co-administrator David Wall, along with facility infection prevention nurse Diana Wall, RN, BSN. During the meeting, RM Helbling went over and elaborated each item of the Stipulation and Waiver; And Order (“Stipulation”) that was effective on June 18, 2021. Prior to this meeting, the vendor/trainer submitted by facility for evaluation was approved by RM Helbling. Questions from meeting participants, including questions regarding training, were answered by RM Helbling and LPM Montes. All meeting participants stated that they understood the Stipulation at the end of the meeting. RM Helbling confirmed that the Department’s transparency website has been updated to reflect the probationary status of the facility. David Wall agreed to submit a copy of the facility’s most updated Personnel Report (LIC500) to the licensing office, attention LPM Montes, by end of business day tomorrow, July 8, 2021. No deficiency cited during this visit. This report was reviewed with David Wall, co-administrator, and a copy of this report was provided electronically for signature.

On May 24, 2021 Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced case management visit. LPA met with Diana Wall, RN,BSN,PHN,IP and Administrator Dillon Cagulada showed up at a later time. LPA toured the facility, observing the 3rd floor Covid wing, kitchen/ dining area, main lobby, two PPE rooms that were fully stocked, ground floor, ground floor break rooms and laundry room, and ground floor lobby. LPA observed all staff wearing PPE throughout the facility, which included front desk satff, caretakers, kitchen staff, and the activities director. LPA also observed residents who were out of their rooms wearing face masks as well. No deficiencies observed today. This report was discussed with Diana Wall RN,BSN,PHN,IP and Administrator, Dillon Cagulada and a copy of this report was provided via email.