Jennifer Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility for annual inspection. LPA was greeted by caregiver Suzete Tamayo who was informed the reason of the visit. There was (2) additional staff, and residents at the kitchen table eating lunch. Today's current census was (6). Facility license/sketch, rights of resident council, grievance/complaint procedures, emergency disaster plan, resident bill of rights, personal rights, infection control procedures. A physical plant tour of the facility inside and outside was conducted. The following common areas: living, dining, kitchen, resident bedrooms, and bathrooms were inspected. Kitchen: LPA observed a Licensing requirement of (7) day nonperishable, and (2) perishable, with (2) extra refrigerator stocked with food located in the garage. Food was labeled and properly stored in a healthy manner. Appliances were functional, clean, and in good repair. Chemicals, medication, household supplies, and knives, were secured and unlocked in the garage and kitchen area. Living/dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (5) bedrooms, with (1) shared room. All bedrooms were properly furnished and supplied with appropriate bedding and linens and were in good repair. There are sufficient linens and towels observed. Bathrooms: There are (2); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. There is outside furniture located in the front and back of the facility for resident's use. Smoke alarms and carbon monoxide detectors were tested and operating properly. Gates were unlocked and easily accessible. Fire extinguisher fully charged. First aid kit furnished fully equipped. All exit doors have alarms; all were operating. Record review: A complete record review of staff and residents were conducted; no errors observed. All Licensing documents observed in files. Medication review: No errors observed; facility in compliance. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Feb 12, 2026

Type of visit: Required - 1 Year

On 2/04/2025 at approximately 09:40 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by Administrator Suzette Tamayo. LPA stated the reason for their visit. LPA asked for census, Staff/Resident Roster, and Insurance. LPA conducted a physical plant tour at approximately 11:00 AM and the following was noted: There is only one entrance being utilized at the facility. The facility is a single unit building with five (5) bedrooms and two (2) bathrooms currently occupying six (6) residents. There is no designated staff room. The facility has approved fire clearance for six (6) non-ambulatory residents. Hospice waiver approved for one (1). Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Common areas: Living room and dining room observed to be neat, clean, and organized. Both rooms observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 73°F. Fire extinguisher located in the kitchen and dated 07/30/24. Required postings such as See/Say Something, Long-Term Ombudsman, and Resident’s Rights are located aside the dining room. Fireplace: Observed to be covered and inaccessible to residents. Working telephone observed. Kitchen: Kitchen observed to be clean and inaccessible to pests. Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods were observed. Knives and sharps observed to be locked in bottom kitchen cabinet. Kitchen appliances observed to be working and in proper condition. (continued on LIC 809-C) Bedrooms: The Residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers stored in storage closet located in hallway’s passageway. Bathrooms: Bathrooms were checked for cleanliness and proper operation. Appropriate grab rails and skid mats were observed and in proper condition. The hot water temperature was measured within regulations at 115.0°F. Garage: The garage can be accessed from inside the facility and is kept locked. LPA observed locked storage cabinets within the garage used to store cleaning solutions, toxins, and laundry detergents. Extra refrigerator and freezer stocked with additional food for residents. Laundry Room: The laundry room is located inside the garage. Laundry appliances observed to be working and in proper condition. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water in this facility. Locked storage unit observed. The front of the facility is also equipped with a seating area for residents. Medications: Medication logs and facility files kept stored in locked filing cabinet aside the kitchen. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer, and manual. Smoke detectors and carbon monoxide observed to be working properly and were tested. Last Fire Drill conducted on 10/25/24. Resident/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. There was no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility at 11:30pm to conduct Annual inspection. LPA was greeted by Administrator Suzete Tamayo who allowed LPA to enter. There was (1) additional staff, and residents at the kitchen table eating lunch. Today's current census was (5). Facility license/sketch, rights of resident council, grievance/complaint procedures, emergency disaster plan, resident bill of rights, personal rights, infection control procedures,and Ombudsman poster, was visibly posted. Administrator certificate current and valid until July 21, 2024. A physical plant tour of the facility inside and outside was conducted with Administrator. The following common areas: living, dining, kitchen, resident bedrooms, and bathrooms were inspected to ensure the facility was in compliance with Title 22 Regulations: Kitchen: LPA observed a Licensing requirement of (7) day nonperishable, and (2) perishable, with (2) extra refrigerator stocked with food located in the garage. Food was labeled and properly stored in a healthy manner. Appliances were functional, clean, and in good repair. Chemicals, medication, household supplies, and knives, were secured and unlocked in the garage and kitchen area. Living/dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (5) bedrooms, with (1) shared room. All bedrooms were properly furnished and supplied with appropriate bedding and linens. Rooms observed to have bedspreads, sheets, pillowcase, mattress pad, and blankets, and were in good repair. There are sufficient linens and towels observed. Bathrooms: There are (2); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured at 105.8. degrees Fahrenheit. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. There was no swimming pools or other bodies of water. There is outside furniture located in the front and back of the facility for resident's use. Smoke alarms and carbon monoxide detectors were tested and operating properly. Gates were unlocked and easily accessible. Fire extinguisher fully charged. First aid kit furnished fully equipped. All exit doors have alarms; all were operating. Record review: A complete record review of staff and residents were conducted; no errors observed. All Licensing documents observed in files. Training was current and update. Medication review: No errors observed; facility in compliance. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Feb 8, 2024

Type of visit: Required - 1 Year

LPA attempted to conduct a 1 year required visit at this facility but staff informed the LPA that both them (staff) and residents are Covid positive.the state’s words, verbatim · CDSS document, Jan 7, 2024