We Care Elderly Care #3

Type of visit: POC

On 07/20/2026, at 02:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct this Plan of Correction (POC) inspection. Upon entry, the LPA explained the purpose of the visit to Caregiver Jillian Morris. On 07/03/2026, the LPA conducted a Required 1-Year inspection. During that inspection, 14 citations were issued. During this POC inspection, 14 of the 14 citations were cleared. Exit interview conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 20, 2026

Type of visit: Required - 1 Year

On 07/03/2026, at 08:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct this Required 1 Year inspection. Upon entry, the LPA explained the purpose of the visit to Caregiver Jillian Morris. Administrator (ADM) Brittany White arrived at approximately 12:30 PM and departed at approximately 5:30 PM. The LPA toured the community inside and outside. The tour of the community included, but was not limited to, residents’ rooms, bathrooms, the kitchen, common areas, the garage, and the yards. The community was clean, appropriately furnished, and well lit. There are no bodies of water on the grounds of the community. The walkways in both the interior and exterior of the community were free from obstructions. The residents’ bathrooms are equipped with grab bars and slip-resistant mats. At 11:36 AM, the refrigerator temperature was measured at 34 degrees and the freezer at -10 degrees Fahrenheit. At 1:47 PM, the maximum hot water temperature was measured at 113 degrees Fahrenheit. There is more than the required minimum of a 7-day supply of nonperishable foods and a 2-day supply of perishable foods on hand. The centrally stored medication cabinets were locked. At 3:06 PM, the inside temperature was measured at 68 degrees Fahrenheit in the front room. Continued on LIC 809-C . . . . . . Continued from LIC 809 The LPA observed the required postings in the community. Carbon monoxide and smoke detectors were operational. The fire extinguisher was last replaced on 02/02/2025. The Emergency Disaster Plan was not reviewed by the ADM. Emergency and disaster drills were not conducted for the sufficient number of staff each quarter. The first aid kit was observed to be complete, and staff dispense medications directly from the original container to residents. The liability insurance is current. An administrator is on site more than the minimum of 20 hours a week to ensure proper business operations are being conducted. The LPA reviewed community records, 5 resident records, and 5 staff records. 1 Type A and 13 Type B citations were issued during this inspection. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 809-D. Failure to submit Proof of Corrections (POCs) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 3, 2026

Type of visit: Case Management - Health Checks

On this day, March 17, 2026, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a health and safety inspection as a result of the Department receiving a priority 1 complaint (Complaint # 15-AS-20260311110348). LPA met with Jena Tatum, administrator (ADM), and informed the reason for visit. LPA also met with Brittany White, co-administaror (Co-ADM). LPA toured the facility including but not limited to common areas, dining room, kitchen, bedrooms, bathroom, side and backyard. LPA observed the following: -staff (S1) who stated started working on February 18, 2026 is not fingerprint cleared. -resident (R1) does not have Pre-placement Appraisal. -R1 was sent out to the emergency on November 2025 and although facility has Unusual Incident Report dated more that 7 days after the incident, there's no proof it was submitted to the Department. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty for S1 who is not fingerprint cleared. Failure to submit proof of corrections by plan of correction due dates and any repeat violation within 12 month period may result in additional civil penalties. Deficiencies and plan and proof of corrections were discussed with ADM. Exit interview conducted. Appeal Rights, LIC421IM Civil penalty assessment, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Mar 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Mar 18, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance.....as required ... -This requirement is not met as evidenced by: -Based on review of record, interview and upon checking of Guardian Portal, the licensee did not comply with the section in having S1 worked without being fingerprint cleared which posed an immediate risk to persons in care.the state’s words, verbatim · CDSS document, Mar 17, 2026

Plan of correction: S1 left while LPA was at the facility. Administrator stated she'll not have S1 work. Self-certification to be submitted by 3/18/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Mar 31, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for ..the resident within seven days of the occurrence of any of the events.... -This requirement is not met as evidenced by: -Based on interviews and record review, the licensee did not comply with the section above in not submitting incident report when R1 was sent out which posed a potential safety, health and/or personal rights risks to person in care.the state’s words, verbatim · CDSS document, Mar 17, 2026

Plan of correction: Copy of incident report was provided to LPA on this day. In addition, administrator to ensure timely submission and submit self-certifcation by 3/31/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Mar 31, 2026

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455...... -Thi requirement is not met as evidenced by: -Based on interview, the licensee did not comply with the section above in not doing Pre-Admission Appraisal prior to R1's admission which posed a potential health, safety and/or personal rights risks to person in care.the state’s words, verbatim · CDSS document, Mar 17, 2026

Plan of correction: R1 is no longer at the facility. Administrator to read the Regulation and self-certify that Pre-Admission Appraisal will be completed prior to resident's admission.

Type of visit: Prelicensing

On 07/02/25 around 3:55 PM, Licensing Program Analyst (LPA) L Holmes arrived announced to conduct a pre-licensing Inspection. LPA was greeted by Lurinza Bean, Licensee, and Jena Tatum, Administrator (ADM) and explained the purpose of the visit. ADM's Standard Certificate #6023328740 expires 05/20/26. Licensee and LPA toured the facility including but not limited to the common areas, dining room, bathrooms, kitchen, bedrooms, garage and backyard. The facility consists of four (4) bedrooms and 2 bathrooms. Outdoor and indoor passageways were free of obstruction. There were not any bodies of water present. A comfortable temperature was maintained at 72 degrees Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the residents; additional linen, toiletries, and paper goods were readily available. The hot water temperature in the shared bathroom was measured at a minimum required degrees (F) of 105. The shared bathroom had a hand washing sign, paper towels, toilet paper, soap and garbage cans; all areas were safe and sanitary. PPE, sanitizer, and paper goods remain sufficient. There will be a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. Smoke/carbon monoxide detectors were in operating condition during visit. Fire extinguisher was observed full and serviced 02/02/25. Emergency Disaster Plan was updated. Safety drills will be performed on a rotational basis. LPA reviewed files closet and medication six (6) locked medication storages. The following forms are to be updated and submitted to CCLD: -LIC500 Personnel Report & Resident Roster (TBD) -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610 Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) (Reviewed) Continued on LIC809C... ...continued from LIC809. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided to Jena Tatum, Administrator.the state’s words, verbatim · CDSS document, Jul 2, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 07/02/25 around 4:45 PM, Licensing Program Analyst (LPA) L Holmes arrived announced to conduct a pre-licensing Inspection. LPA was greeted by Lurinza Bean, Licensee, and Jena Tatum, Administrator (ADM) and explained the purpose of the visit. ADM's Standard Certificate #6023328740 expires 05/20/26. LPA discussed the COVID-19 infection control requirements, the importance of attending the informational calls, understanding the updated guidelines and printing the provider information notices (PINS) for residents, authorized representatives and staff so that the facility maintains awareness and updates for compliancy with the Title 22 regulations. -Component III completed. Exit interview conducted and a copy of this report provided to Jena Tatum, Administratorthe state’s words, verbatim · CDSS document, Jul 2, 2025

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: JENA TATUM, LURINZA BEAN Interview Method: Telephone interview On May 30, 2025, 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 the understanding of the California Code Title 22 Regulations. 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. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 30, 2025