9th Avenue Community Care Home

Type of visit: Required - 1 Year

On 3/11/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Nancy Supetran, Caregiver and explained the purpose of the visit. LPA toured the physical plant. This is a 3-story building but only the 2nd level is the facility. The building has 4 bedrooms, 2 bathrooms, a kitchen, dining room, garage, and backyard. No accessible bodies of water or hazards were observed. All bedrooms had the required furniture and sufficient lighting. All bathrooms had anti-skid flooring, shower mats, and grab bars. The facility's smoke alarms and Carbon Monoxide detectors were observed to be in working order. The facility's fire extinguishers were observed to be fully charged. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility's first aid kit was observed to have all of the required items. All sharp objects, soap, detergent, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 5 resident files and 3 staff files. All were observed to be complete. According to the Administrator, all staff have recently completed their CPR/First Aid training however, no documentation could be provided. A Type B citation was issued for this deficiency. LPA received copies of the facility's current liability insurance policy and Administrator's certificate. The facility handles cash resources/personal and incidental(p&i) money for clients. All money matched the records kept at the facility. A review of Centrally Stored Medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. Deficiencies are cited under California Code of Regulations(CCR) Title 22. Failure to correct deficiency by the Proof of Correction due date may result in civil penalties. An exit interview was conducted. A copy of the report along with Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 11, 2026

Type of visit: Required - 1 Year

On 2/5/2025, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Administrator, Ren So. The facility currently provides care for 6 residents, none of which are receiving hospice services, or with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located throughout the facility were found to be charged. Smoke detectors were present in each common room and resident bedroom. Carbon monoxide detector located in hallway was tested an in working order. Emergency disaster plan is reviewed and updated on a regular basis. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen refrigerator found to have appropriate coverings, enough for residents in care. Cleaning supplies and other toxins are safely stored upon inspection. There was a supply of hygiene products and paper products available for residents. Resident's bedroom have lighting & appropriate furnishings and bedding items. Restrooms for resident use were equipped with non-slip mats, grab bars and kept in good condition. There is a large outdoor patio equipped with appropriate shading for resident use. Medications are stored in the kitchen and found to be secured. Upon spot review of medications, LPA found that the facility has centrally store medication records updated and in order. LPA conducted a sample file review for residents and found that residents have updated physician's reports and Individual Service Plans up to date. Upon a sample review of 3 staff files LPA found that all caregiver staff have current 1st aid and CPR certification, annual training, health screening reports on file. LPA requested the following documents be sent to CCL by COB 2/19/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, Feb 5, 2025

Type of visit: Required - 1 Year

On March 29, 2024 at 9:25 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Nancy Supetran, Caregiver and explained the purpose of his visit. LPA Calandra also called and spoke with Administrator, Renelee So who was unavailable to join the visit and explained the purpose of his visit. LPA Calandra toured the physical plant. This is a 1 story building with 3 bedrooms, 2 bathrooms, a kitchen, dining room and living room. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire extinguishers were observed to be fully charged and last checked on 11/8/2023. The facility's fire and Carbon Monoxide detectors were observed to be in working order. All bedrooms had sufficient lighting and the required furniture. Night lights were observed to be in working condition in the hallway. Hot water temperature was measured at 113.3 degrees Fahrenheit well within the required range of 105-120 degrees Fahrenheit. No food was expired. The facility has the required 7 days of non-perishables and 2 days of perishables on site. The Washer and Dryer were observed to be in good repair. All sharp objects, detergent, poisons, and medications were locked up and in-accessible to persons in care. All Personal & Incidental(P&I) money kept at the facility matched facility records. LPA Calandra reviewed 5 client files. All were observed to be complete except for two which were missing pre-admission appraisals. LPA Calandra also reviewed 5 staff files. All were observed to be complete. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA Calandra interviewed 2 clients and 1 staff member. A Type B violation was provided for not completing a pre-admission appraisal for R1 and R2. Deficiencies are cited under California Code of Regulations, Title 22, cited on the LIC 809-D. Failure to correct the deficiencies may result in civil penalties. This report was reviewed with Nancy Supetran, Caregiver and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Mar 29, 2024