J & M Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to the facility to conduct an one year required inspection. LPA Lund met with Juanito De La Cruz and explained the purpose of the visit. LPA Lund and Juanito De La Cruz toured/inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility is licensed for six ambulatory residents, which two may be non-ambulatory and reside in bedroom two. There are currently 5 residents who reside at this facility. LPA Lund reviewed two staff files and three resident files, which were maintained. The facility has the required postings throughout the facility. LPA Lund reviewed 3 medication administration records (MARs), which were maintained. Fire extinguisher (12/12/2025), smoke detectors, and carbon detectors were in good repair and in compliance. The water temperature measured at 110 degrees and facility temperature measured at 70 degrees. The facility had an adequate food supply, and all toxins were stored in a locked cabinet. No deficiencies cited. An exit interview was conducted, and a copy of this report.the state’s words, verbatim · CDSS document, Jun 24, 2026

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 09/04/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff person Juanito De la Cruz. A brief interview was conducted with the facility staff person at this time. This LPA requested that the facility staff person go ahead and contact the facility designated Administrator, Arlyn De la Cruz, to inform her that CCL was present at this time. Current census was 6 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 06/27/2025. This visit was to follow up on the Plans of Correction that were due. The following deficiencies were observed and cited on 06/27/2025: The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This facility did complete the Plans 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 staff person 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, Sep 4, 2025

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 06/27/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility on-call staff person, Sandra Glover, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Arlyn De la Cruz, to inform her that CCL was present at this time for an annual visit. This LPA was able to speak with the facility designated Administrator, Arlyn De la Cruz, on the phone and learned that she was at a personal engagement, funeral service, and would not be able to attend and be present for this annual visit at this time. She indicated that all authority was given to the caregiver, Sandra Glover, who was currently present to be able to sign and engage with this LPA at this time. It was learned that the husband, Juanito De la Cruz, was out of the facility at this time due to a personal medical appointment and would be available later on once his appointment had been fulfilled. Juanito De la Cruz did arrive later to this facility after this LPA had toured and was in the process of conducting the file review for this annual visit. Current census was 5 residents. Tour of the facility was conducted. Living area, dining area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient, in good repair, and able to meet the needs of the residents at this time. Kitchen area was toured. Cabinets and drawers were opened and the contents were reviewed at this time. Items for preparing, cooking, and serving meals unto the residents were observed to be sufficient and in compliance at this time. Cleaners and cleaning agents were observed to be locked and made inaccessible to the residents at this time. Fire extinguisher, located hanging on the wall adjacent to the refrigerator, was observed to have been annually inspected on 12/13/2024 by the local fire extinguisher company, Jorgensen Fire, and was in compliance at this time. Medication cabinets located in the kitchen area were observed to be locked and made inaccessible to the residents at this time. First aid kits were observed to be present and contained all of the required components at this time. Food supply, and food storage units, were observed to be sufficient and able to meet the needs of the residents at this time. This facility was observed to have, on hand at all times, a sufficient supply of 2-day perishable and 7-day nonperishable food quantities at this time. A tour of the facility bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the facility restrooms was conducted. Grab bars, non skid mats, and toiletries were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees at this time. A review of the laundry room was conducted. Bleach, detergent, and all other laundry supplies were observed to be locked and made inaccessible to the residents at this time. Garage area was toured. It was observed that this area was used mainly to store facility related items at this time. Exterior grounds of this facility were toured. Facility perimeter fence, side gates, and all other exits were reviewed at this time. Administrator certificate for the facility designated Administrator, Arlyn De la Cruz, was observed to be present with certificate number 7001834740 and set to expire on 11/24/2025. A review of (3) facility personnel files was conducted and noted on the following LIC 859. A review of (5) facility resident files was conducted and noted on the following LIC 858. 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. This facility was assessed a civil penalty in the amount of $500 on the following LIC 421 BG. Appeal Rights were printed and a copy was given to the facility representative at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jun 27, 2025

Type of visit: Required - 1 Year

On 06/14/2024 Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Juanito De La Cruz and Arlyn De La Cruz and explained the purpose of the visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility is licensed for six ambulatory resident, which two may be non-ambulatory and reside in bedroom two. There are currently 4 residents who reside at this facility. LPA Martinez toured the facility with Juanito De La Cruz and Arlyn De La Cruz on 06/14/2024 at 1:00 PM. LPA Martinez reviewed two staff files and four resident files, which were maintained. The facility has a natural disaster plan, and the last fire drill was on June 08, 2024. The facility has the required postings throughout the facility. LPA Martinez reviewed 4 medication administration records (MARs), which were maintained. LPA Martinez requested medication orders for Client 1 Omega-3 1,000 MG. LPA Martinez requested client's 2 stool softener 100 MG medication order. Orders should be emailed to LPA Martinez by June 21, 2024 5:00 PM. LPA Martinez requested a copy of the Infection Control Plan- LIC 9282 and liability insurance The Administrator agreed to email the requested documents to LPA Martinez by June 21, 2024 5:00 PM. Fire extinguisher, smoke detectors, and carbon detectors were in good repair. The water temperature measured at 110 degrees and facility temperature measured at 70 degrees. The facility had an adequate food supply, and all toxins were stored in a locked cabinet. Based on this annual inspection, there were no deficiencies cited. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 14, 2024

Allegation investigated: Staff made inappropriate comments towards resident

On 4-25-24 at 10:16am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced at facility to deliver findings for the allegation noted above. LPA met with Administrator Arlyn De La Cruz and explained the purpose of the visit. LPA displayed identification upon entry. During this investigation, LPA conducted interviews with two staff members and three residents in care. LPA also reviewed facility file documentation including appraisal and physician report for resident1 (R1). Allegation: Staff made inappropriate comments towards resident. LPA conducted interviews and record reviews as stated above. Based on interviews conducted, it was determined that R1 and S1 engaged in a verbal exchange of inappropriate language during R1’s residency at the facility. The contents of this verbal exchange included R1 using foul language towards S1 to which S1 responded with foul language directed at R1. As a result, the preponderance of evidence standard has been met, and this allegation is SUBSTANTIATED. Deficiencies are cited and noted on LIC 9099D. An exit interview was conducted with Arlyn De La Cruz and a copy of this report was provided to Arlyn. Appeal rights provided. Substantiated provides comfortable sleeping accommodations. Additionally, interviews revealed no corroborated statements of residents made to sleep outside of facility. As a result, there is not a preponderance of evidence to conclude staff are not ensuring comfortable accommodations for sleeping, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff did not ensure resident had proper clothing violating resident rights. This allegation stated facility made a resident sleep outside and unclothed. LPA conducted interviews, record reviews, and observation as noted above. Based on observation it was determined that residents in care have appropriate amounts of clothing for various weather conditions and stored appropriately in rooms for use. LPA observed residents in care to be properly clothed during visit on 3-6-24. Interviews conducted did not reveal any corroborated statements of residents maintaining unsuitable amounts of clothing or being made by staff to sleep outside of the facility while unclothed. As a result, there is not a preponderance of evidence to conclude staff are not ensuring proper clothing for residents, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Arlyn De La Cruz, and a copy of this report was provided to Arlyn. Appeal rights provided.the state’s words, verbatim · CDSS document, Apr 25, 2024 · control 27-AS-20240228115950

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: May 6, 2024

Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature…This requirement was not met as evidenced by: Based on interviews, S1 directed inappropriate language towards R1. This posed a potential health, safety, and resident rights risk to resident in care.the state’s words, verbatim · CDSS document, Apr 25, 2024

Plan of correction: Licensee will ensure completed staff training on resident rights and submit proof of completed training to LPA by POC due date. Licensee to include training on staff disengagement from potential negative interactions with residents.