JMS Home for Senior

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Mariana Agban conducted a Case Management–Incident visit at the above facility. Upon arrival, LPA met with facility staff and explained the purpose of the visit.On May 22, 2026, Community Care Licensing (CCL) received a Death Report regarding Resident #1 (R1). According to the report, on May 8, 2026, at approximately 4:00 PM, R1 was sitting in the living room watching television. R1 then stood up and began walking toward the front door. While approaching the front entrance, which contains a low ramp, R1 reportedly slipped, fell backward, and struck their head. The Death Report indicated that Staff #1 (S1) immediately responded and assessed R1. S1 observed a small bump on R1’s head, along with a minor laceration and scant bleeding. S1 contacted R1’s wife and informed her of the incident. According to the report, R1’s wife instructed staff not to call emergency medical services immediately and advised that she would be arriving at the facility shortly. Approximately 20 minutes later, R1’s wife arrived at the facility and decided to contact emergency medical services. R1 was subsequently transported to Holy Cross Medical Center for evaluation and treatment. The Death Report further indicated that R1 was later diagnosed with a skull fracture and moderate intracranial bleeding.During today’s visit, LPA interviewed two staff members and obtained copies of R1’s records for review. At this time, LPA is unable to close out the investigation. Additional information needed prior to concluding investigation. Facility representative was advised and a copy of this report given.the state’s words, verbatim · CDSS document, Jun 17, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Designee Lydia Olila and explained the reason for the visit. At approximately 09:15 am, with the assistance of Administrator Designee, LPA took a tour of the physical plant. Required postings were observed in the entry area. The fire extinguisher is located in the dining area. .LPA tested the smoke alarms and found that they function properly; however, the carbon monoxide detector was not functioning properly. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were four (4) bedrooms designated for residents' use. Two (2) bedrooms are designated for private use, and two (2) rooms are shared. All four bedrooms in use by residents were properly furnished with appropriate beddings and linens and with sufficient lighting. Bathrooms: There are three (3) bathrooms designated for residents' use. All bathrooms were properly supplied and had functional fixtures. The hot water temperature from the main bathroom sink was measured at 115.2 degrees Fahrenheit. No cleaning supplies or hazardous items were present in the main bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards.The gates at both sides of the home were checked to ensure no locks were installed, and that exits and passageways were clear for emergency evacuation. The laundry room: The Laundry door is locked, and thus, chemical hazards are inaccessible to residents. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. LPA observed that R1 has incomplete physician report and R2 has no updated Physician Report. In addition, R2 and R3 have no hospice care plan. (Continue on 809C) Staff Files: LPA also conducted a file review of staff records to ensure staff records are in compliance. Medications: Medication and Medication Records were reviewed for proper documentation. Temperature: Facility maintains a comfortable temperature of 75 degrees Fahrenheit. Exit interview conducted, citations issued, appeal rights given and copy of this report signed and deliveredthe state’s words, verbatim · CDSS document, Mar 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Designee Lydia Olila and explained the reason for the visit. At approximately 10:45 am, with the assistance of Staff#2 (S2), LPA took a tour of the physical plant. Required postings were observed in the entry area. The fire extinguisher is located in the dining area. The purchase date is March 3, 2025. LPA tested the smoke alarms and found that they function properly. The carbon monoxide detector was tested, and it functions properly. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were four (4) bedrooms designated for residents' use. Two (2) bedrooms are designated for private use, and two (2) rooms are shared. All four bedrooms in use by residents were properly furnished with appropriate beddings and linens and with sufficient lighting. Bathrooms: There are three (3) bathrooms designated for residents' use. All three bathrooms were properly supplied and had functional fixtures. The hot water temperature from the bathroom sink was measured at 112.3 and 113.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry room: The Laundry door is locked, and thus, chemical hazards are inaccessible to residents. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. LPA observed that R2 has no updated Physician Report. R3 has an incomplete physician Report. LPA also observed that there's no hospice care plan for R4, indicating the need for the full rails. LPA observed R1, R2, and R3 have 1/2 bed rail without physician order. (Continue on 809 C) Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. LPA observed that there's no physical file for the Administrator. Medications: Medication and Medication Records were reviewed for proper documentation. Exit Interview conducted, citations issued, appeal rights given, and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Designee Lydia Olila and explained the reason for the visit. At approximately 8:45 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The fire extinguisher is located in the dinning area. The purchase date is March 1, 2024. LPA tested The smoke alarms were tested and function properly. The carbon monoxide detector was tested and functions properly. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were four (4) bedrooms designated for residents' use. Two (2) bedrooms are designated for private use, and two (2) rooms are shared. All four bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting.Bathrooms: There are three (3) bathrooms designated for residents' use. All three bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 110.4 and 109.9 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit.Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry room: Laundry door is locked and thus chemical hazards are inaccessible to residents. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were review for proper documentation.Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Mar 1, 2024