Most inspections found no deficiencies, including the most recent complaint investigation on March 19, 2025, which was unsubstantiated and cited no violations. Earlier reports showed some deficiencies related mainly to medication management, resident supervision, and documentation, with civil penalties totaling $1,350 assessed in November 2024. There were also isolated issues involving unlocked cleaning supplies and medication storage posing safety risks, as well as fingerprint clearance and staff training concerns. Several complaint investigations were unsubstantiated, and no immediate jeopardy or license actions were reported. The facility’s record shows improvement over time, with the latest inspections free of deficiencies after addressing prior concerns.
An unannounced complaint investigation was conducted in response to allegations including neglect resulting in resident dehydration and development of pressure injuries while in care.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Residents were given adequate fluids and repositioned regularly. No deficiencies were cited.
Complaint Details
The complaint was unsubstantiated after investigation. Allegations included neglect causing dehydration and pressure injuries, but evidence did not prove violations occurred.
The inspection was conducted as a health and safety check following a complaint received on 2024-11-26.
Findings
The facility was found to be clean, in good repair, and residents appeared safe. No imminent health or safety concerns were noted and no deficiencies were cited during the visit.
Complaint Details
The visit was triggered by a complaint received on 2024-11-26. No deficiencies or violations were found, and no imminent health or safety concerns were identified.
Employees Mentioned
Name
Title
Context
Janice Gambio
Administrator
Arrived during the inspection and was involved in the visit.
Isabel Poderoso
Campus Director
Met with Licensing Program Analysts and explained the reason for the visit.
The inspection was an unannounced Required - 1 Year annual inspection conducted to evaluate compliance with licensing regulations at Milan Villa Senior Living Facility.
Findings
The inspection identified multiple deficiencies including lack of a bedridden fire clearance, uncleared staff fingerprint clearance, missing admission agreement, missing current medical assessment for a resident, unlocked medication in a resident's room, and medication not administered according to doctor's orders. Civil penalties totaling $1350 were assessed.
Severity Breakdown
Type A: 4Type B: 2
Deficiencies (6)
Description
Severity
Having a bedridden resident without a bedridden fire clearance.
Type A
Having uncleared staff (S5) at the facility without fingerprint clearance.
Type A
Not having admission agreement for resident R5.
Type B
Not having current medical assessment for resident R2.
Type B
Unlocked medication in resident's room.
Type A
Not administering resident R3's medication according to doctor's orders.
The inspection was conducted as a case management visit in response to an incident report received on 2024-09-19 regarding a resident who was missing from the facility.
Findings
The inspection found that a resident (R1) was missing from the facility with a locked room door and broken window screen, posing a potential health and safety risk. The facility called 911 and the resident was returned with police involvement. The physician's report stated the resident cannot leave unassisted. A deficiency was cited for failure to comply with regulations regarding resident supervision.
Complaint Details
The visit was complaint-related due to an incident report about a resident missing from the facility. The deficiency was substantiated as the resident was found missing and the facility failed to ensure adequate supervision.
Severity Breakdown
Type B: 1
Deficiencies (1)
Description
Severity
Additional Personal Rights of Residents in Privately Operated Facilities. Licensee did not comply by having a resident missing from the facility which poses a potential health and safety risk.
Type B
Report Facts
Deficiency Type: 1Census: 18Total Capacity: 24
Employees Mentioned
Name
Title
Context
Isabel Poderoso
Campus Director
Met with Licensing Program Analyst during inspection and involved in incident discussion.
An unannounced case management visit was conducted by Licensing Program Analyst G. Luk to observe compliance and facility conditions.
Findings
A deficiency was observed where unlocked medication and vitamins were left unattended on a medication cart accessible to residents, posing an immediate health and safety risk. Staff acknowledged incorrect medication and vitamins were given, and were advised to keep medications locked and inaccessible.
Severity Breakdown
Type A: 1
Deficiencies (1)
Description
Severity
Unlocked medication and vitamins left on top of medication cart accessible to residents, posing an immediate health and safety risk.
Type A
Report Facts
Capacity: 24Census: 18
Employees Mentioned
Name
Title
Context
Janice Gombio
Administrator
Met during inspection and involved in findings discussion
Isabel Poderoso
Campus Director
Met during inspection and involved in findings discussion
Grace Luk
Licensing Program Analyst
Conducted the inspection and observed the deficiency
An unannounced complaint investigation was conducted due to an allegation that staff did not ensure the facility was free from pests.
Findings
The investigation included interviews with residents, staff, and the complainant, as well as a review of pest inspection reports and inspection of residents' beds. No evidence of bed bugs or other insects was found, and the allegation was determined to be unsubstantiated with no deficiencies cited.
Complaint Details
The complaint was unsubstantiated as there was not a preponderance of evidence to prove the alleged violation occurred.
Report Facts
Capacity: 24Census: 18
Employees Mentioned
Name
Title
Context
Janice Gombio
Administrator
Met with Licensing Program Analyst during investigation
Isabel Poderoso
Campus Director
Met with Licensing Program Analyst during investigation
The inspection was an unannounced Required - 1 Year annual inspection conducted to evaluate compliance with licensing regulations and facility standards.
Findings
The inspection identified multiple deficiencies including lack of current annual training for staff, missing medical assessments and reappraisals for residents, absence of TB test or chest x-ray results for some residents, missing prescribed medications, lack of fingerprint clearance for a staff member, and insufficient nonperishable food supplies. Civil penalties were assessed for fingerprint clearance and medication availability violations.
Deficiencies (6)
Description
Staff S3 did not have current annual training completed.
Residents R3 and R4 did not have TB test or chest x-ray results on file.
Resident R2 did not have prescribed medications available and no discontinue orders for them.
Staff S4 was not fingerprint cleared and left the facility during the visit.
Facility did not have one week of nonperishable food supplies available on premises.
Resident R1 did not have current medical assessment and residents R1-R5 did not have current reappraisal needs and service plans on file.
Report Facts
Civil penalty amount: 500Civil penalty amount: 500Facility capacity: 24Facility census: 15Plan of Correction due date: Dec 15, 2023Plan of Correction due date: Nov 28, 2023Plan of Correction due date: Nov 22, 2023
Employees Mentioned
Name
Title
Context
Janice Gombio
Administrator
Met during inspection and involved in plan of correction agreements
Unannounced infection control inspection conducted as a required 1-year visit to assess compliance with infection control and safety regulations.
Findings
The inspection found unlocked cleaning supplies and laundry detergent accessible to residents, and only one available shower room for 16 residents with two others used for storage. These deficiencies pose health and safety risks and were cited with plans of correction required.
Deficiencies (2)
Description
Unlocked cleaning supplies and laundry detergent accessible to residents, posing an immediate health and safety risk.
Only one shower available for 16 residents, with two other shower rooms filled with storage items, posing a potential health and safety risk.
Report Facts
Capacity: 24Census: 16Plan of Correction Due Date: Nov 19, 2022Plan of Correction Due Date: Nov 25, 2022
Employees Mentioned
Name
Title
Context
Bibi Barase
Admission and Marketing Director
Met with Licensing Program Analysts during inspection
The inspection was an unannounced Infection Control Inspection conducted as a required 1-year visit to assess compliance with infection control regulations.
Findings
The facility was generally compliant with infection control practices including COVID-19 protocols, hand hygiene, and PPE availability. One deficiency was observed where the housekeeping door was unlocked with cleaning supplies accessible, posing a health and safety risk. The lock was fixed and verified during the inspection.
Deficiencies (1)
Description
Unlocked housekeeping door with cleaning supplies accessible, posing an immediate health and safety risk to persons in care.
Report Facts
Capacity: 24Census: 13
Employees Mentioned
Name
Title
Context
Janice Gombio
Administrator
Met during inspection and involved in addressing deficiency
Isabel Poderoso
Campus Director
Met during inspection
Inspection Report Original LicensingCensus: 15Capacity: 24Deficiencies: 0Nov 19, 2020
Visit Reason
The inspection was a Tele-visit Pre-licensing inspection conducted via Zoom due to shelter in place directives, to evaluate the facility's readiness for licensing approval.
Findings
No issues were noted during the inspection. The facility was observed to be ready to be licensed, with all areas toured and safety measures in place, including fire clearance, medication storage, and emergency plans.
Report Facts
Fire extinguisher last serviced date: Jul 8, 2020Emergency disaster plan completion date: May 29, 2020Hot water temperature: 107Non-perishable food supply: 7Perishable food supply: 2
Employees Mentioned
Name
Title
Context
Toby Tilford
Licensee
Spoke with Licensing Program Analyst during inspection
Maria Agcaoili
Administrator
Spoke with Licensing Program Analyst during inspection
Isabel Poderosa
Campus Director
Spoke with Licensing Program Analyst during inspection
Janice Gombio
Administrator in training
Spoke with Licensing Program Analyst during inspection
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