Crossroads Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jason Lund arrived at facility unannounced to conduct a one year required annual visit. LPA Lund met with Administrator Jerry Caparros and explained the reason for the visit. Census: 6 LPA Lund & Administrator Jerry Caparros toured/inspected the facility and grounds including the kitchen, living room, dining room, bedrooms, laundry room and bathrooms. The facility was observed to be clean and free of odor. The carbon monoxide, smoke detectors and fire extinguisher (1/16/2026) found to be in compliance. The first aid kit was observed to be complete with scissors, tweezers, thermometer, manual and various wound dressings. The facility maintains a 2- day supply of perishable food and 7- day supply of non-perishable food. The facility also maintains an emergency supply of food and water. The knives, medications and cleaning supplies were observed to be locked and inaccessible to residents in care. The facility bathrooms were observed to be equipped with grab bars at the toilets and shower. The shower had non-slip flooring. The water temperature in the bathroom was within the required regulatory range of 105-120 degrees. The thermostat was set at 74 degrees. LPA Lund observed an adequate supply of linens. The grounds were observed to be well maintained, and paths were free of obstruction. The backyard has ample seating space and shade for outdoor activities. LPA Lund reviewed three residents & two staff files and were in compliance. No deficiencies were issued as a result of this visit. An exit interview was conducted and a copy of this report was left.the state’s words, verbatim · CDSS document, Mar 25, 2026

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 03/07/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff person, Teneisha Morris, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Jerry Caparros, to inform him that CCL was present at this time for an annual visit. The facility designated Administrator returned back to this facility shortly thereafter while this LPA was conducting this visit. Current census was 6 residents. It was learned that there were (3) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (4) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (5) residents diagnosed with dementia at this time. It was learned that there were (3) residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6005959740, for Jerry Caparros was observed to have an expiration date of 07/27/2025 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility kitchen cabinet, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the office area, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguishers were located throughout this facility and observed to have been annually inspected by the local fire extinguisher company, Assured Fire Extinguisher Company, on 01/10/2025 and found to be in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (2) facility personnel records was conducted on the LIC 859. A review of (6) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Mar 7, 2025

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 06/13/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Jerry Caparros. A brief interview was conducted with the facility designated Administrator at this time. Current census was 5 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior visit conducted on 03/27/2024 and to follow up on the Plan of Correction. The following deficiencies were observed and cited on 03/27/2024: All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. (A) When any medical assessment, appraisal, or observation indicates that the resident's dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This facility did complete the Plan of Correction and provided all of the required forms and documents at this time. Plan of Correction clearance letters were printed and copies were provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jun 13, 2024

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 03/27/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jerry Caparros, who was briefly interviewed. It was learned that there were (4) residents under the care of hospice at this time. It was learned that there were other residents who were receiving services through home health as well. This facility does have a hospice waiver approved for (4) residents since 2020. This facility also has, on file, a program to accept and retain residents diagnosed with dementia at this time. Current census was 6 residents. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Jerry Caparros. Forms and documents were submitted to renew for Certificate #6005959740 that is set to expire on 07/27/2025. Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in hallway closet, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated Administrator at this time. The medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the facility laundry area, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 01/15/2024 by the local fire extinguisher company, Assured Fire Extinguisher Services, and in compliance at this time. First aid kit was observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (5) facility resident files was conducted and noted on the following LIC 858. A review of (5) facility personnel files was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Mar 27, 2024