336412451-3-4-2026-18-AS-MLAD-DRURB5-20260304115211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336412451
Report Date: 03/04/2026
Date Signed: 03/04/2026 11:53:07 AM

Document Has Been Signed on 03/04/2026 11:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	BRENTWOOD OF RANCHO MIRAGE II		FACILITY NUMBER:	336412451
ADMINISTRATOR/ DIRECTOR:	DVILLAR/RVILLAR CO-ADMIN		FACILITY TYPE:	740
ADDRESS:	26 BUCKINGHAM WAY		TELEPHONE:	(760) 321-2239
CITY:	RANCHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY: 6		CENSUS: 2	DATE:	03/04/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:50 AM
MET WITH:	Imelda Villar- House Manager		TIME VISIT/ INSPECTION COMPLETED:	11:55 AM

NARRATIVE
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	On March 4, 2026, Licensing Program Analyst (LPA), Mia Lankford arrived at the facility unannounced to conduct the Annual Inspection and met with the House Manager, Imelda Villar. The facility file review was conducted and additional records were requested and reviewed on site. The facility is licensed for six Elderly Adults and is currently operating at a capacity of two adults. LPA Lankford toured the facility along with the House Manager, Imelda Villar and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Additionally, there were bodies of water on the premises with a locked gate around it. The facility isf a single story home. Physical Plant: LPA Lankford observed the two(2) resident’s bedrooms, and each was furnished with required fixtures as per Title 22. LPA Lankford inspected the facility bathrooms, and the hot water temperature tested within regulations, and logged at 111.4 degrees. The bathrooms were clean, and appliances were operable at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers dated 2/18/26. LPA Lankford observed required postings such as "If you See Something, Say Something,” the "Personal Rights," and the LTCO poster in hallway. The cleaning supplies and sharp items were locked and inaccessible to the residents in care. There were designated storage spaces for the residents’ and staff’s files, and the file were locked in a cabinet. Medications: The medications were locked in the kitchen cabinet. The medication records were maintained and keep with the medications in locked cabinet. There were no documented errors observed on the Medication Administration Record.The LPA observed the pantry to be clean, neat, and organized. CONT...809C

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Mia Lankford
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRENTWOOD OF RANCHO MIRAGE II	FACILITY NUMBER: 336412451
	VISIT DATE: 03/04/2026

NARRATIVE

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Food Service& furniture: The kitchen was clean and free of any seen pest, clutter, or unsightly debris. The non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for the residents in care at the time of this visit. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. The facility heating system and other appliances were operable at present time of visit. The House Manager informed the LPA there were safety lights for night throughout the facility, and the LPA observed these as indicated.
Care & Supervision/Administration: Currently there are adequate staff present for the care and supervision of the residents in care. There are two staff available at the time of this annual visit. The listed Administrator Derick F Villar possesses a current administrator’s certificate with an expiration date of 10/02/2026. The staff files reviewed have criminal clearance, updated training, along with current First Aid certification. Resident files reviewed possessed the required paperwork as per Regulations at the present. Including current physical and TB test, along with updated IPP’s.

Disaster preparedness: LPA Lankford reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the Department standards and was conducted as required per standards, it was given on 12/5/2025.
Infection Control: LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility in laundry room. LPA reviewed the facility's infection control plan and found required infection control measures met the Department requirements.

An exit interview was conducted. A copy of this report was reviewed and given to the House Manager, Imelda Villar.

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Mia Lankford
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026

LIC809 (FAS) - (06/04)

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