Care Jordan 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Francis Parilla. Administrator (AD) Julie Cornejo arrived at approximately 12:00 p.m. and the purpose of the inspection was discussed. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home, consisting of four resident bedrooms, one staff room, three bathrooms, and attached two-car garage. LPA observed Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) posted in the main entryway of the facility met regulatory 20” x 26” in size requirement. All resident bedrooms had the required furnishings. LPA observed all residents’ beds had linens and blankets. LPA observed three of five residents leaving for mass and observed two of five residents resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested at 109.9 degrees Fahrenheit. LPA observed the backyard has a shaded sitting area and the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguishers were observed to be fully charged with service tags dated June 30, 2026. Gas stove, microwave, laundry washer and dryer were all observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and locked. LPA reviewed five of five resident files and three staff files. Two of five resident files did not include an examination for Communicable tuberculosis; a Deficiency was cited on today’s date. (Cont. LIC809-C) Based on observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jul 17, 2026

Type of visit: Required - 1 Year

On July 7, 2025, at 1:00 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Staff Julie Cornejo and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory, of which one (1) can be bedridden and has a hospice waiver for six (6) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: four (4) residents bedrooms, one (1) staff bedroom, three (3) bathrooms, an attached 2-car garage, living area, dining area, kitchen, and an outdoor covered seating area. LPA Kim toured inside and outside of the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: resident room 1, resident room 2, resident room 3, and resident room 4. Bathrooms were found to be clean and operational. The water temperature measured between 110.6 degrees F and 111.9 degrees F. A comfortable temperature of 73 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water and emergency supplies are stored in the garage. All mandated inspection control posters were posted. The facility has smoke detectors and carbon monoxide detectors that were operable. The Certificate of Liability Insurance is effective from August 30, 2024, to August 30, 2025. The facility conducted a Fire/Safety Drill on May 29, 2025, and conducts drills quarterly. One (1) fire extinguisher was mounted in the dining area. First Aid Kit contained all the necessary elements. LPA Kim conducted an audit of four (4) residents (R1-R4) files, and five (5) staff (S1-S5) personnel files, and medication and medication administration records that were all in order and complete. LPA conducted interviews for two (2) residents and two (2) staff. No deficiencies were cited during the inspection visit. An exit interview was conducted, and a copy of this report was provided to staff Julie Cornejo.the state’s words, verbatim · CDSS document, Jul 7, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicant Gideon Limpiado and toured the facility. An application for Change of Location (CHOL) to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on February 15, 2024. The facility is to have a capacity of six, of which five can be nonambulatory and one bedridden. Facility phone number 714-203-1342. LPA observed the following. Structure: The facility is a one-story house with four resident bedrooms, one staff bedroom, three full size bathrooms, a living room, a kitchen, a dining room, and an attached car garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall by the dining room. There is one gate in the backyard, which both is self-closing and self-latching. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are four resident bedrooms. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. CONTINUED ON LIC809-C... Bathrooms: All bathrooms are clean and have working plumbing. Hot water measured between 107.8 and 110.1 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen for each resident was stored in a closet by the resident's bedrooms hallway. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Sample menu was available in the file. Food Service: There are no residents living in the facility at this time. There is 7-day non-perishable food supply on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. There is a fire extinguisher mounted on the wall by the laundry room and one by the dining room. Appliances: There is one, four gas burner stove which lights unassisted, one oven, one microwave, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored in a locked cabinet in the garage. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 107.8 and 110.1 degrees Fahrenheit. Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in the closet by the dining room. The first aid kit has all the required elements. Medications will be stored in a locked cabinet by the dining room. Resident & Staff Files: The Resident and Staff Records will be kept in a locked cabinet by the dining room. Reading Material, Games, Equipment & Materials: Arts and craft, board games, books and puzzles are stored in a central storage in the living room. There is one large screen television in the living room. Fire clearance: Fire Clearance approved by a fire inspector of Orange County Fire Authority on April 24, 2024. Special conditions noted, "As per approved plan." Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB (Central Applications Bureau) in Sacramento. Exit interview was conducted and a copy of this report was left with the applicantthe state’s words, verbatim · CDSS document, Jun 7, 2024