JW Care Home

Type of visit: Case Management - Annual Continuation

On 9/29/2025 at approximately 09:50 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual continuation visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. The Administrator, Jojomaureli Salamero arrived shortly after to assist with today’s visit. The updated census for the facility is four (4). Common areas: The living room and dining room were observed to be in proper condition. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 70°F. LPA observed a fire extinguisher to be located near the kitchen and dated 08/26/2025. LPA observed required postings such as See/Say Something and Personal Rights to be located alongside the hallway’s passageway. A working telephone was observed. LPA observed the fireplace to be covered and inaccessible to residents. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. The cleaning solutions/toxins/knives/sharps were observed to be kept locked underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed to be stored in storage closet located within the hallway’s passageway. Staff room: LPA observed staff room to be locked. (Continue to LIC 809-C) Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations. LPA observed appropriate grab rails and slip-resistant mats to be 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 located at the facility. Garage: The garage can be accessed from inside of the facility with its entrance observed to be located in the staff room. The garage was observed to be kept locked and used for storage purposes. Laundry Room: The laundry appliances were observed to located within the garage. The laundry appliances were observed to be working and in proper condition. Medications: The medications where observed to be kept in locked cabinet located in the hallway’s passageway. First-aid kit observed to be equipped with but not limited to bandages, scissors and tweezer. LPA observed the First-Aid Manuel to be missing. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records were observed to be incomplete. Staff records: LPA conducted a file review of staff records. Staff records appeared to be incomplete. Per LPA’s initial annual visit on 8/26/2025 deficiencies were observed. Today’s annual continuation visit observed additional deficiencies that will be cited. Citations issued, please refer to 809-D There were no other immediate health and safety hazards observed during the day of inspection. Exit interview conducted, appeal rights given and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 29, 2025

Type of visit: Required - 1 Year

On 8/26/2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. The Administrator, Jojomaureli Salamero arrived shortly after to assist with today’s visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 12:00 PM and the following was noted: The facility is a single-story building with five (5) bedrooms and two (2) bathrooms. The facility is currently occupying three (3) residents. There is a designated staff room. The facility has an approved fire clearance for five (5) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver approved for four (4). (Continue to LIC 809-C) The following deficiencies were observed: - The only staff member present upon LPA’s arrival did not have proof of First-Aid/CPR training, initial training and dementia training - The Administrator’s certificate expired: 7/05/2024 - All four staff documentation were missing and/or incomplete - 1 of 3 residents were missing a pre-appraisal - All 3 residents missing Needs and Service Plans - 1 of 3 residents requires awake staff due to wandering behavior documented on their Physician’s Report - In the backyard LPA observed an accessible storage unit unlocked containing multiple cans of paint and toxins Due to time constraints, the yearly annual will need to be completed at a later date. Citations will be issued at later date. Exit interview conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted a One Year Required visit at this facility today and met with the Administrator Jojomaureli Salamero. LPA informed the administrator the purpose of the visit. At 1:03 PM, A tour of the physical plant was conducted with Ms. Salamero. The facility has five (5) bedrooms and two (2) bathrooms currently occupying four (4) residents. One (1) bedroom is designated for staff use. The facility fire cleared for five (5) non-ambulatory residents, one of which maybe bedridden. Infection control: The facility has submitted and approved Mitigation Plan and Infection Control plan on file. The main door is the only entrance being utilized at the facility. Screening area is located in immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Hand washing sign are posted on the bathroom. The facility has an approved Infection Control and Mitigation 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. The facility maintains a comfortable temperature at 75°F. The smoke detectors and alarms are interconnected and hardwired and observed to be fully operational. There is a carbon monoxide installed and observed to be operational. The door alarms were also and observed to be operational. The fire extinguisher is located at the dining room and observed to be full and current. The front of the facility has outdoor furniture and the backyard has shaded area. There is no body of water at the facility. The garage was observed to be locked and inaccessible to residents and also being used as Laundry area, storage for frozen food, PPE, other supplies, laundry detergent, cleaning agents and other toxins. The backyard has a locked tool she being used as old equipment storage. (continued on LIC 809-C) (continued from LIC 809) 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, detergents and/or toxins are stored in the cabinet below the kitchen sink and were locked and inaccessible to residents. Knives and sharps are also locked in a kitchen drawer. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are appropriately lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Staff Rooms: Staff room was locked. No medication was 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 hot water temperature measured at a range of 109.3°F to 111.2°F . Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications: LPA observed the medication in the bedroom hallway cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. The first aid kit was complete and stored in the medication cabinet. Client records: All client records wee reviewed. Client 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. Disaster drill was last conducted on 09/08/24. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Oct 6, 2024