Jordan Senior Home

Type of visit: Required - 1 Year

On 09/04/2026, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required Annual/comprehensive inspection. LPA Singh met with a staff and was granted entry to the facility. At the time of the visit there were two (2) staff present, and Six(6) residents present. Licensee/Administrator Shaden Hussein arrived during the visit. LPA Singh explained the purpose of the visit to Licensee/Administrator Shaden Hussein. The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room, laundry area and garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) are ambulatory residents. The facility has two (2) Hospice waiver and Assisted living waiver (ALW). The current census is six (6) residents. LPA Singh was accompanied by Licensee/Administrator Shaden Hussein to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA observed no obstructions to indoor passageways. The facility is maintained at a comfortable temperature of 77 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps and chairs and sufficient lighting in the bedrooms. Moreover, LPA observed that bathrooms were clean, and appliances were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms LPA observed night light maintained in hallways and passages to non-private bathrooms. LPA observed the outdoor passageways free of obstructions. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the resident bathroom to be at 119 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the Community Care Licensing Division(CCLD) complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. Cleaning supplies and sharps were kept inaccessible to residents in care There was a designated storage space near dining area, for resident/staff files. There is a cabinet with the resident’s medications locked in the medication cabinet. Food Service: Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Emergency food and water supply was stored Care & Supervision: LPA observed sufficient number of staff to provide care and supervision to the residents in care and staff scheduled to work at night as required for facility with dementia residents. Completed Emergency Kit and first aid manual observed at the facility. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings with tuberculosis (TB) test results. LPA also reviewed Administrator's file for certification and training. Records review was completed, no issues. Facility emergency/ disaster/fire drill conducted on 08/07/2026. Liability Insurance valid through 12/19/2025-12/19/2026. LPA Singh reviewed medications administration records(MAR), no issues. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the of the California Code of Regulations. An exit interview was conducted where this report, LIC809, LIC809C were discussed and provided to Licensee/Administrator Shaden Hussein.the state’s words, verbatim · CDSS document, Sep 4, 2026

Type of visit: Required - 1 Year

On 10/28/25 at 3:30 PM, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Singh met with a staff and was granted entry to the facility. At the time of the visit there were one (1) staff present, and four(4) residents present. Licensee/Administrator Shaden Hussein arrived during the visit. LPA Singh explained the purpose of the visit to Licensee/Administrator Shaden Hussein. The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room, laundry area and garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) are ambulatory residents. The facility has two (2) Hospice Waiver. The current census is four (4) residents. LPA Singh was accompanied by Licensee/Administrator Shaden Hussein to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA observed no obstructions to indoor passageways. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps and chairs and sufficient lighting in the bedrooms. Moreover, LPA observed that bathrooms were clean, and appliances were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms. LPA observed night light maintained in hallways and passages to non-private bathrooms. LPA observed the outdoor passageways free of obstructions. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the resident bathroom to be at 116 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. Cleaning supplies and sharps were kept inaccessible to residents in care There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the medication cabinet. Food Service: Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Emergency food and water supply was stored Care & Supervision: LPA observed sufficient number of staff to provide care and supervision to the residents in care and staff scheduled to work at night as required for facility with dementia residents. Completed Emergency Kit and first aid manual observed at the facility. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings with tuberculosis (TB) test results. Staff#2 did not have TB Test and current CPR/first aid on file, deficiency will be issued. In addition, Facility does not have emergency/ disaster/fire drill conducted quarterly on file. deficiency will be issued. Liability Insurance valid through 12/19/2024-12/19/2025. LPA Singh reviewed medications administration records(MAR). LPA observed activity program for the residents at the facility. An exit interview was conducted where this report, LIC809, LIC809C were discussed and provided to Licensee/Administrator Shaden Hussein.the state’s words, verbatim · CDSS document, Oct 28, 2025

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Beena Singh and Paola Guerrero conducted an announced pre-licensing visit to the facility. LPAs met with Facility Licensee . The pending application is for a Residential Care Facility for Elderly (RCFE). Current capacity is (6). The Administrator accompanied LPAs on a tour of the inside and outside of the facility. The physical plant, in general, was in good repair. The buildings and grounds are free from hazards. The indoor and outdoor passageways are free of obstruction. LPAs observed an in-ground pool at the facility, the perimeter of the pool was gated and locked. All bedrooms are furnished with a bed, nightstand, dresser, and chair. All bedrooms have adequate lighting for resident use. Bathroom's toilet, shower and tubs are in good repair and have non-skid mats. LPAs observed food storage and preparation areas to be clean and sanitary. LPAs inspected facilities freezer and Refrigerators logs all listed appropriate temperatures according to Title 22 regulation. All appliances are clean and operating properly. The outdoor space is suitable for residents use. LPAs observed fully charged fire extinguishers present in the facility. Smoke alarms and carbon monoxide are present and functional. Facility has a designated cabinet where medications are locked and stored. There is adequate seating in the common areas. Facility had a supply of activities for the residents. An exit interview was conducted, and a copy of this report was provided to Facility Licensee Shaden Hussein.the state’s words, verbatim · CDSS document, Oct 4, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Shaden Hussein, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Sep 23, 2024