JMS Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced visit at this facility for a One (1) year Required visit. LPA met with staff Nora Rosales who called the administrator Madonna Olila and explained the purpose of the visit. Ms. Olila designated Ms. Rosales to sign the report. A tour of the physical plant was conducted at 12:20 PM. The facility has six (6) bedrooms and four (4) bathrooms currently occupying three (3) residents on four (4) private rooms and one (1) shared room. One (1) bedroom and one (1) bathroom is designated for the staff. The facility fire cleared for six (6) non-ambulatory residents, one of which may be bedridden in Room #1. Hospice waiver for two (2) residents. There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation plan and Infection plan. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 75°F. The carbon monoxide and smoke detector are tested and observed to be operational. Smoke detectors are hardwired and interconnected. Fire extinguisher was observed to be full and last bought on 06/14/26. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water at the facility. (continued on LIC 809-C) (continued from 809-C) There is a two (2) car port located at the back of the facility. There is a detached separate house at the vicinity which is currently being used as a storage and staff rest area. The house was locked during visit. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies, pesticides and other toxins are stored in a kitchen cabinet and observed to be locked and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene products on each bathroom which is provided by the licensee. Staff Rooms: Staff rooms are locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The sink on the bathroom in between Rooms #1 and 2 has a leak. The hot water temperature measured at a range of 105.3°F to 108.6°F. There is sufficient supply of clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. Complete first aid kit is readily available. Client records: Client records are reviewed and observed to be complete and current. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 05/28/26. Required posting observed in facility (complaint hot line poster). Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jun 19, 2026

Allegation investigated: Staff do not provide a safe environment for residents in care

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Nora Rosales who called Administrator Madonna Olila and explained the reason for the visit. Ms. Olila designated Ms. Rosales to sign the report. LPA conducted physical plant tour at 9:18 AM, requested copies of facility documents at 9:45 AM, reviewed documents between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that Staff do not provide a safe environment for residents in care, it was alleged that Resident #1 (R1) hit Resident #2 unprovoked. LPA's record review revealed that both R1 & R2 are independent and able to care for themselves but R1 had a history of being aggressive towards staff not on any other residents. LPA's interview with Staff #1 (S1) who witnessed the entire incident revealed that on 04/24/26 at around 4:30 PM, S1 went to the dining area to pick up a call from the facility's landline and when S1 learned that the call was for R2, S1 summoned R2 who took the call on the landline. While talking on the phone, R1 passed by and hit R2 in the head without any provocation. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with R2 confirmed the account of S1 that R2 came and hit R1 in the head with R1's fist. Another resident, Resident #3 (R3) also witnessed the incident and confirmed that there was no provocation from anyone when R1 hit R2 in the head when R1 passed by on the dining area where they were seated. Both R2 and R3 admitted that no one could have prevented it as there was no provocation whatsoever. LPA's interview with another staff also revealed that it was R2's friend who called the police because it happened while they were talking on the phone. The police came about an hour later and picked up R1 and brought R1 to hospital and had not returned to the facility. LPA's interview with the Administrator today at 1:11 PM revealed that R1 is no longer coming back at the facility as they found out that R1 was keeping two (2) axes and fan knife on R1's bedroom and surrendered it to the police. Further, Administrator added that VA was informed that due to this dangerous episode and aggression they could no longer take R1 back, VA agreed that R1 should no longer be back at the facility. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 5, 2026 · control 31-AS-20260428111224

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced visit at this facility for a One (1) year Required visit. LPA met with staff Nora Rosales who called the administrator Madonna Olila and explained the purpose of the visit. Ms. Olila designated Ms. Rosales to sign the report. A tour of the physical plant was conducted at 12:26 PM. The facility has six (6) bedrooms and four (4) bathrooms currently occupying five (5) residents on four (4) private rooms and one (1) shared room. One (1) bedroom and one (1) bathroom is designated for the staff. The facility fire cleared for six (6) non-ambulatory residents, one of which may be bedridden in Room #1. Hospice waiver for two (2) residents. There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation plan and Infection plan. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 75°F. The carbon monoxide and smoke detector are tested and observed to be operational. Smoke detectors are hardwired and interconnected. Fire extinguisher was observed to be full and last bought on 06/26/25. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water at the facility. (continued on LIC 809-C) (continued from 809-C) There is a two (2) car port located at the back of the facility. There is a detached separate house at the vicinity which is currently being used as a storage and staff rest area. The house was locked during visit. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies, pesticides and other toxins are stored in a kitchen cabinet and observed to be locked and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene products on each bathroom which is provided by the licensee. Staff Rooms: Staff rooms are locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The sink on the bathroom in between Rooms #1 and 2 has a leak. The hot water temperature measured at a range of 105.3°F to 107.2°F. There is sufficient supply of clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. Complete first aid kit is readily available. Client records: Client records are reviewed. Residents 1 & 2 (R1 & R2) has dementia diagnosis but no updated Medical Assessment on file. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 04/25/25. Required posting observed in facility (complaint hot line poster). Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jun 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced visit at this facility for a One (1) year Required visit. LPA met with staff Nora Rosales who called the administrator Madonna Olila and explained the purpose of the visit. Ms. Olila designated Ms. Rosales to sign the report. A tour of the physical plant was conducted at 12:32 PM. The facility has six (6) bedrooms and four (4) bathrooms currently occupying four (4) residents on four (4) private rooms and one (1) shared room. One (1) bedroom and one (1) bathroom is designated for the staff. The facility fire cleared for six (6) non-ambulatory residents, one of which may be bedridden in Room #1. Hospice waiver for two (2) residents. There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation plan and Infection plan. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 75°F. The carbon monoxide and smoke detector are tested and observed to be operational. Smoke detectors are hardwired and interconnected. Fire extinguisher was observed to be full and last bought on 06/20/24. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water at the facility. (continued on LIC 809-C) (continued from 809-C) There is a two (2) car port located at the back of the facility. There is a detached separate house at the vicinity which is currently being used as a storage and staff rest area. The house was locked during visit. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies, pesticides and other toxins are stored in a kitchen cabinet and observed to be locked and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene products on each bathroom which is provided by the licensee. Staff Rooms: Staff rooms are locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The sink on the bathroom in between Rooms #1 and 2 has a leak. The hot water temperature measured at a range of 105.9°F to 111.2°F. There is sufficient supply of clean linen available in stock at the cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. Complete first aid kit is readily available. Client records: Client records are reviewed. Client records appear to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 06/20/24. Required posting observed in facility (complaint hot line poster). Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jul 7, 2024