Southern Comfort Care Home 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Andrew Martinez arrived unannounced to conduct the required annual comprehensive inspection of the facility. LPA was greeted by Caregiver Eve Cisneros Cortez and Caregiver Marshall Bass Morales, explained the purpose of the visit and was granted access to the facility. LPA was informed that the current census is two (2) residents, with the two (2) staff members present in the facility. Licensee Joanne Castin was contacted by facility staff to inform them of LPA's presence. Licensee stated Administrator Shanda Rimorin was unavailable due to an emergency. Licensee Joanne Castin assisted facility staff and LPA via telephone calls. The facility is a single-story home with five (5) resident bedrooms, three (3) bathrooms, one (1) staff bedroom, kitchen, dining area, living room, laundry room, backyard and attached two and a half (2 1/2) car garage. LPA was accompanied by Caregiver Eve to conduct a general overall inspection of the facility which included but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). LPA observed there are no obstructions to indoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit (F). Facility water temperature was measured at 109 degrees F. LPA inspected all resident bedrooms observing four (4) of (5) to be equipped with required furniture such as mattresses, nightstands, storage space, chairs, and sufficient lighting; (1) resident, Resident #1's (R1), bedroom was observed to be without a bed. Licensee disclosed to LPA that bedding furniture was initally provided to R1 at time of admission, however, R1 declines used of bed and elects to sleep in her own recliner(s). Licensee stated R1's family and physician are aware of R1's refusal of use of bed and election to use her recliner(s) only, but no documentation has been obtained/retained approving this exception. One (1) Type B deficiency will be issued. LPA inspected resident bathrooms which were observed to be clean with all plumbing fixtures found operational and in working order. LPA observed multiple waste receptacles located within resident bedrooms and bathrooms to be without a tight-fitting cover. One (1) Type B deficiency will be issued. *** Continued on LIC 809-C *** The facility is equipped with combination smoke alarm and carbon monoxide detectors that were tested and observed to be working properly. Two (2) fully charged fire extinguishers were observed in the facility. LPA observed the facility maintains a fully stocked first aid kit, however, the facility's First Aid Manual could not be located by staff. Licensee purchased a replacement during LPA's visit and provided proof of purchase to LPA. One (1) Technical Violation will be issued. Posters such as the Resident Personal Rights, Long Term Care Ombudsman, CCL complaint poster, emergency phone numbers, and emergency disaster plans were all posted in a common area. LPA also observed cleaning supplies, toxins, sharps, and other dangerous items locked in cabinets made inaccessible to residents. There was a designated storage space for resident and staff records/files. There are no pools or open bodies of water, no fireplace observed, and no guns, ammunition, or other dangerous weapon are stated to be stored on property. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a wide variety of food available for residents. Dishes, cups, and utensils were also stored properly. Yards/Outside: Facility has one shaded patio, and a side gate with self-latching handle on the northeast side of the house that leads into the backyard. LPA observed the facility's four (4) large residential solid waste bins were to be obstructing the outdoor passageway leading out of the side gate from the back to the front of the property. Facility staff relocated all four (4) solid waste bins to another location to clear the outdoor passageway prior to LPA completing visit. One (1) Type B violation will be issued and cleared as a same-day correction. Medications: Medications were observed secured, centrally stored, and are kept inaccessible to residents in care. Medications were audited at random by LPA. Medication audit revealed that one (1) resident's (R1) medication was observed to be stored without a medication label, and one (1) resident's (R1) medication was being transferred from its originally stored medication container into another. Two (2) Type A deficiencies will be issued. Licensee stated the Administrator pre-sorts residents' medications in the morning by transferring residents' medication that was stored in its originally received container into separate daily pill organizer containers. Licensee also stated facility is awaiting to establish care for R1 with a primary care physician to complete orders for R1's current medications. Care & Supervision: The facility has sufficient care staff for coverage 24 hours a day, 7 days a week. *** Continued on LIC 809-C *** Record Review: LPA reviewed resident record files for admission agreements, updated physician reports, and needs and services plans. Resident record file reviews revealed that two (2) of two (2) resident's record file contained incomplete and/or unsigned admissions agreements from either the resident, a resident representative and/or the licensee or licensee's designee. Resident record file reviews also revealed that two (2) of two (2) resident's record file did not contain pre-placement appraisals. Two (2) Type B deficiencies will be issued. LPA reviewed employee personnel files for criminal background clearances, medical assessments/health screening report including Tuberculosis (TB) test results, CPR/First Aid certifications, and required training. Employee personnel file reviews revealed that all personnel records were not available for Licensing for inspection, and all personnel records were not maintained at the facility for at least two (2) staff; staff #1 (S1) and staff #2 (S2). Two (2) Type B deficiencies will be issued. Employee personnel file reviews also revealed that (1) staff member (S2) could not provide a health care screening with TB test results to be verified by LPA, and one (1) staff member's (staff #3 (S3)) health screening report was incomplete. One (1) Type A deficiency will be issued. Furthermore, employee personnel file reviews revealed one (1) staff member's criminal record clearance was not transferred appropriately to the facility. LPA verified through the online Guarding Background Check System that staff #2 (S2) was not associated to facility. One (1) Type A deficiency will be issued. LPA reviewed facility records for valid liability insurance, reviewed and/or updated Infection Control Plan, reviewed and/or updated Emergency and Disaster Plans, quarterly emergency drills, and Designation(s) of Facility Responsibility. Review of facility records revealed the facility did not designate an authorized person who is continuously present at the facility during operational hours to represent the facility and to accept licensing reports. LPA observed the posted Designation of Facility Responsibility LIC 308 form, signed and dated on 10/01/2025 by Licensee, designates an individual who also is not reflected on the facility's Personnel Report LIC 500. Licensee Joanne Castin and Administrator Shanda Rimorin were not on property for the duration of LPAs visit. One (1) Type A deficiency will be issued. Based on LPA's observation, interviews, and record reviews, five (5) Type A deficiencies, seven (7) Type B deficiencies, and one (1) Technical Violations are being cited per Title 22 California Code of Regulations. An exit interview was conducted where this Facility Evaluation Report (LIC 809/LIC 809-Cs/LIC 809-D) were discussed, and Plans of Corrections were developed between LPA and Licensee. Copies of all above-stated reports, along with Appeal Rights, were left for Licensee Joanne Castin and Administrator Shanda Rimorin at the conclusion of the visit, in the care of Caregiver Marshall Bass Morales whose signature on all forms confirms receipt.the state’s words, verbatim · CDSS document, Sep 23, 2026

The state marks this report as 12 pages; the online copy we transcribed has 11. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Licensee Joanne Rimorin and Administrator Shanda Rimorin and introduced self and stated purpose of the visit. LPA was informed that there are currently 5 residents in care who are in the facility. The facility has 4 resident bedrooms, 1 resident bathroom, 2 staff bedrooms with 1 bathroom, kitchen, dining area, living room, laundry room, attached garage, and backyard. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathroom; bathroom was clean and appliances were found functional. Water temperatures tested at 109 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, fire extinguisher and first aid kit. Posters such as; the personal rights, ombudsman, CCL complaint poster and emergency disaster plans were posted in a common area. LPA also observed cleaning supplies, toxins, sharps, and other dangerous items locked in cabinets made inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed secured and inaccessible to residents. There are no guns or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a wide variety of food available for residents. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, a side gate with self-latching handle on the right side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed personnel and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff. LPA reviewed the facility's insurance coverage, emergency disaster plan, infection control plan and emergency drills. No deficiencies were cited during this visit. An exit interview was conducted where this report LIC809, and LIC809C were discussed and copies were provided to the Licensee, Joanne Rimorin and Administrator, Shanda Rimorin.the state’s words, verbatim · CDSS document, Oct 25, 2025

Type of visit: Prelicensing

On 10/03/24 at 9:10AM, Licensing Program Analysts (LPA's) Renese Howell-Small and Melody Brown conducted an announced visit to the facility for the purpose of a Prelicensing Visit. LPA's met with Applicant Joanne Casten and Administrator Shanda Mae Rimorin. An initial application for license to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 06/15/24 for a total capacity of six (6). Fire clearance was granted on 06/05/24 for five (5) non-ambulatory residents and one (1) bedridden. LPA's Howell-Small and Brown observed the following: Structure: Facility was a single story house with six (6) bedrooms; six (6) bedrooms for residents and no staff bedrooms, three (3) resident/staff bathrooms, living room, dining area and kitchen. There is an attached two (2) car garage. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control the entire house. LPA's Howell-Small and Brown observed the temperature to be 72 degrees Fahrenheit. Bedrooms: Each resident bedroom accommodates any non-ambulatory resident. Room "F" is the only approved room for bedridden. All resident bedrooms were adequately furnished with bed, closet, appropriate linen and an operable combined carbon monoxide/smoke alarm. Technical Assistance given for mattress pads, lamps, dressers and chairs for the bedrooms. Bathrooms: The three (3) staff/resident bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. LPA's tested the water temperature in the resident bathrooms. LPA's verified water temperature was measured at 110 degrees Fahrenheit. Continued on LIC809C ***CONTINUED FROM LIC809*** Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked cabinet located in the hallway. There was adequate room for food storage. LPAs observed the stove to be operational. Refrigerator/freezer were in working condition. There is more than seven (7) days’ supply of non-perishable foods and more than two (2) days’ supply of non-perishable foods. There’s an adequate seating for meals for all residents. Laundry room with washer and dryer. Laundry detergents and cleaning supplies are stored in the chemical storage room. Technical Assistance given to provide trash bins with tight fitting lids. Living/Family room: There’s a living/family room with adequate seating for all residents and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. Gates on the right side of the facility. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted in the hallway. Ombudsman poster, Let-Us-No poster, Personal Rights, Emergency Disaster Plan were observed. Dementia Care Plan: LPAs Renese Howell-Small and Melody Brown observed and reviewed the Dementia Care Plan during the visit. General items: two (2) fire extinguisher(s) were charged and located throughout the facility. Dual smoke alarms and carbon monoxide detectors were tested and were observed to be in working order. Resident records will be stored in a locked cabinet in the office room. First Aid kit with required components, First Aid book and locked area for medication storage was observed. LPA's observed a facility phone and was operational as evidenced of LPA dialing the number. ***CONTINUED ON LIC 809C*** ***CONTINUED FROM LIC 809C** The phone number designated for the facility is (951) 599-0172. The required 72-hour emergency food supply was observed. Technical Assistance given to obtain additional water and emergency supplies. Component III was completed on this day as well. LPAs observed activities for the residents such as books, games and magazines. Additionally, upon entry, LPAs observed the facility having Visitor Sign In/Sign Out Sheet and Resident Sign In/Sign Out Sheet. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report was reviewed and provided to Applicant Joanne Casten.the state’s words, verbatim · CDSS document, Oct 3, 2024

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): COMP II Participants: Shanda Mae Rimorin, Joanne Casten Rimorin Interview Method: Telephone interview On August 28, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Medications/Unusual Incidents 3. Staffing requirements & Training 4. Pre-Licensing inspection readinessthe state’s words, verbatim · CDSS document, Aug 28, 2024