Five Acres at Leisure Town North

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection and was greeted by administrator James Sirokman. Facility is a Residential Care Facility for the Elderly that has a fire clearance approved for eleven residents. Facility currently has 10 residents. LPA and staff toured the building and grounds which was found to be clean and in good repair. Facility was clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 6/02/2026. Fire alarms and carbon monoxide detector are hard wired with last inspection completed August 2026. Facility runs on well water with last inspection completed 7/07/2026. Water meets standards per report. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Facility kitchen, refrigerators and freezers were clean, and food was stored properly with expiration dates noted. LPA had conversation with admin that freezers outdoors should be cleaned (Technical advisory given). Toxins are stored in a locked cabinet and inaccessible to residents. Sharps and knives were locked in kitchen drawer. Emergency water and food supply was stored in garage. Facility had an ample supply of linens, towels and extra hygiene products for residents. All bedrooms were equipped with lighting, a night stand and chest of drawers. All bedrooms were clean and in good repair. Resident bathroom had required bath mat and grab bar. Water temperature measured at faucets accessible to residents is within the allowable range of 105 to 120 degrees F. continued onto 809C..... continued from 809.... LPA reviewed 7 resident records. Physician Reports up to date. LPA reviewed 5 staff records. Four out of five staff S1,S2,S3,S4 did not physical reports LIC503. TB Clearance in file. S1 did not have LIC503 or TB clearance in file. (Deficiency cited, see 809D). LPA and staff conducted a spot check of medication and medication records. Medication is centrally stored in a locked cart. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Well water report collected during visit. Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. Exit interview conducted and report read with Administrator.the state’s words, verbatim · CDSS document, Aug 11, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct an Case Management visit and was greeted by staff Alexis York. LPA spoke with administrator Jim Sirokman on the phone and was unable to come to facility. Admin gave verbal permission for Jessuly Ramirez to sign report. On 2/01/2026 CCLD received an incident report regarding staff 1 (S1) and resident 1 (R1), allegation of personal rights. On 1/21/2026 S2 witnessed S1 pull R1 by the shirt, telling R1 to take their pills with S1's hand in their mouth with pills. As stated in the incident report, Admin performed multiple interviews with S1 and S2. Admin determined that S1," violated company policy in two ways, (1) Administering medication and (2) not respecting residents right to refusal." "Due to company's "No tolerance" rule R1 was relived of the position as a med-tech and will no longer handle, manage, or touch mediations." Incident stated that S1 would not be terminated but would undergo additional training. On 1/30/2026 S1 resigned from their position as a caregiver and is no longer working at facility. LPA received resignation letter with requested SOC341 on 2/10/2026. Admin stated S2 is also no longer working at facility and was unable to interview. During todays visit, LPA conducted interviews and received documents. No deficiencies cited during todays visit. Report given and read with administrator Jim Sirokman as he arrived later during facility visit.the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Required - 1 Year

At approximately 12:45PM, Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection. LPA was greeted by facility Administrator(admin) James Sirokman. Facility is a 7 bed, 3 bath Residential Care Facility for the Elderly that has a fire clearance approved for 11 bedridden residents with a hospice waiver approved for 6 residents. LPA and admin toured the building and grounds which was found to be clean and in good repair. Facility was at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 6/03/2024. Facility has commercial fire system through the fire department. Auditory signal systems throughout facility were functional. Outdoor emergency exits clear from obstruction. LPA had conversation with admin about recording all disaster drill conducted. All bedrooms were equipped with lighting, a night stand and chest of drawers. All bedrooms were clean and in good repair. Resident bathroom had required bath mat and grab bar. Water temperature measured at 108.3 degrees F at faucets accessible to residents which is within the allowable range of 105 to 120 degrees. Facility has well water system last inspected on 6/23/2025. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Facility kitchen refrigerators and freezers were clean, and food was stored properly with expiration dates noted. LPA observed food thickener to not be centrally stored, caregiver removed food thickener and placed with centrally stored medication. LPA had conversation with admin to keep all food thickener locked and secure at all times. Extra supply of frozen, perishable, non-perishable food and water located in outdoor workshop. Toxins are stored in a locked cabinet and inaccessible to residents. Sharps and knives were locked in kitchen drawer. Extra linens and towels were stored in closet. Storage shed in backyard stored extra hygiene products for residents. Continued on 809-C..... Continued from 809..... LPA conducted medication spot check and observed all medication to be centrally stored and secure. LPA reviewed 5 resident records. All required documentation was present. Physician reports were up to date. LPA reviewed 4 staff records. All required documentation was present. Staff had required annual and initial training. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit. Exit interview conducted and report read with Administrator.the state’s words, verbatim · CDSS document, Jul 9, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an inspection regarding an incident filed on 05/31/2024. LPA met with Heather Fish, Lead Care Staff. Administrator James Sirokman was out of town, but available by phone. LPA conducted an inspection of the facility and found it to be clean and well-maintained. Residents appeared well-cared for and appropriately dressed. Lunch was being prepared at the time of inspection and there was an ample supply of perishable and non-perishable foods, which were stored as per regulation. LPA reviewed facility records and found that staff member S1, who was named in the incident report had been terminated. There were no citations issued.the state’s words, verbatim · CDSS document, Sep 27, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra conducted an unannounced Annual Required – 1 yr. inspection visit and was greeted by Administrator, Jim Sirokman. Two residents are receiving hospice services. Annual fees are current and contact information was reviewed. Required postings observed. LPA/Administrator toured the facility, it was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms were furnished per regulations. Fire Extinguisher charged and service as of June 2024. Smoke detectors and carbon monoxide detectors throughout the facility were wired connected, tested and found to be operational. The facility is equipped with an additional sprinkler system. Last disaster drill was conducted on 7/10/24. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins stored in designated cabinets located in the laundry room and a storage shed located in the backyard which were both found to be locked and inaccessible to residents in care. There was a supply of hygiene products and paper products available for residents. Water was measured at faucets accessible to residents and measured between 114.3 and 115 degrees F which is within regulation. Medications located in secured carts in the staff office and were found to be secured. Medication and medication records were reviewed. All auditory alarms were operational. LPA initiated file review of five residents and five staff files. One out of five residents (R1) needs medical assessment to be updated (technical violation issued). Care plans are current. LPA/Administrator have discussed the importance of signatures on care plans as a best practice. Staff have current 1st aid/CPR training on file as well as 20 hours of additional required training. Administrator certificate for current Administrator Jim Sirokman #6045410740 expires on 7/1/2025. Administrator agreed to submit copies of the following documents by 8/2/24: LIC 308 Designated Facility Responsibility, LIC 500 Personnel Summary, LIC 610 Emergency Disaster Plan (if there are any changes) and Liability Insurance. No deficiencies cited during today's visit. Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Jul 26, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced for the purpose of conducting a Case Management visit to clear the POC from the visit on 06/03/2024. LPA met with administrator James Sirokman and discussed the corrections made. LPA did a review of three (3) employee files and found that the training records for those employees were in place and complete. Administrator has completed the requirements for clearing the Plan of Correction. No deficiencies cited on this visit. Exit interview conducted with J. Sirokman and copy of this report left on site.the state’s words, verbatim · CDSS document, Jul 12, 2024

Allegation investigated: Staff are not properly trained to adminster medications.

Licensing Program Analysts (LPAs) Nakagawa and Macias arrived unannounced to continue an investigation into the above allegations and deliver findings. LPAs reviewed documents, made observations and conducted interviews. The complaint alleges that personnel files are unorganized and may be out of date, as well as not accurately showing training of staff to administer medications and complete the Centrally Stored Medication List. LPA’s inspection of the facility on 6/03/2024 found that training records were not current. Training records had been found incomplete on 8/8/2023 during a prior inspection and Licensee had not updated the training records as of the inspection on 6/3/2024. Continued on 9099-C Substantiated Continued from 9099-C. Based on LPA’s review of personnel files; there are a lack of records to indicate that Staff are properly trained to adminster and/or document medication records. The allegation that Staff are not properly trained to adminster medications is SUBSTANTIATED. The California Code of Regulations cited on the attached LIC9099D. Deficiencies are cited from the California Code of Regulations (CCRs). Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Continued from 9099-A The complaint also alleges Staff do not properly lock medications and the med cart is left unattended and unlocked. LPAs observed medications were found to be properly locked and secured and the med cart was locked inside the locked doors of the administrative office; therefore the allegations Staff do not properly lock medications and the med cart is left unattended and unlocked are UNSUBSTANTIATED. The complaint also alleges that the Administrator does not have proper certification. The Administrator James Sirokman has a valid RCFE Administrator’s Certificate #7014025740, which is effective to 07/01/2025, therefore the allegation the Administrator does not have proper certification is UNSUBSTANTIATED Finally, the complaint alleges that staff at the facility are not background cleared and have criminal records. A review of documentation show that 10 out of 10 staff have proper background clearance and are associated to the facility, therefore the allegation that staff at the facility are not background cleared and have criminal records is UNSUBSTANTIATED..the state’s words, verbatim · CDSS document, Jun 3, 2024 · control 21-AS-20240314140222

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87412(c) · Plan of correction due date: Jun 3, 2024

87412(c):Personnel Records. Personnel records shall contain verification of required staff training and orientation, as specified. This requirement was not met as evidenced by: Based on LPA’s inspection on 6/3/2024 of personnel records that did not include proof of staff training which is an immediate risk to the Health & Safety of residents in care.the state’s words, verbatim · CDSS document, Jun 3, 2024

Plan of correction: Licensee/Administrator to ensure that all staff receive the required training as specified in Title 22 and that all records are properly recorded in the personnel records of the facility. Licensee to submit plan for immediate training and documentation to LPA Nakagawa by close of business 6/4/2024.