J and V Family Care Home

Type of visit: Required - 1 Year

On 05/8/2026, LPA Grace Donato conducted an unannounced annual inspection. LPA met with Administrator Julita Andaya and explained the purpose of today's visit. The administrator arrived later during today's visit and met with LPA. Facility temperature is comfortable for residents in care. Facility emergency food supplies such as canned goods are in place. Additional supplies are in the garage as well. There are 4 resident rooms. Water temperature is tested in both facility bathrooms. The water temperature is measured at 110F. Cleaning supplies in the kitchen are observed as locked beneath the kitchen sink. Additional cleaning supplies are locked in the garage in a storage cabinet. Facility knives are observed to be locked in a drawer beneath below the kitchen sink. Kitchen food supplies are observed to be in place with 2 day fresh food supply and canned goods fulfilling the 7 day emergency food supply. A tour of the outside of the facility is conducted. Emergency routes are free and clear of any obstructions. No locks are observed on both gates. Smoke detectors and carbon monoxide detectors are located through out the facility. LPA observed all resident rooms and observed that they contain the required furniture and lighting Five resident records and two staff records were reviewed. Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, May 8, 2026

Type of visit: Required - 1 Year

On 04/22/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection. LPA met with administrator Julita Andaya and explained the purpose of today's visit. Currently there are 6 residents in place and 2 staff at time of visit. The administrator arrived later during today's visit and met with LPA. The facility is licensed for age range 60 and over. All may be non-ambulatory. Facility has a waiver for 3 residents. Hospice resident is allowed in bedroom #2 only. There currently are 2 hospice resident in care. This is a single level facility. Facility temperature is comfortable for residents in care. Facility emergency food supplies such as canned goods are in place. Additional supplies are in the garage as well. There are 4 resident rooms. Water temperature is tested in both facility bathrooms. The water temperature is measured at 120F in the bathroom adjacent to room 1 and 130F in the other bathroom located near room 4. Cleaning supplies in the kitchen are observed as locked beneath the kitchen sink. Additional cleaning supplies are locked in the garage in a storage cabinet. Facility knives are observed to be locked in a drawer beneath below the kitchen sink. Kitchen food supplies are observed to be in place with 2 day fresh food supply and canned goods fulfilling the 7 day emergency food supply. A tour of the outside of the facility is conducted. Emergency routes are free and clear of any obstructions. No locks are observed on both gates. Smoke detectors and carbon monoxide detectors are located through out the facility. LPA observed 2 fire extinguishers in the facility. Both are observed as charged and ready for use. Facility does not have disaster drill records on file to review. Linens are in place for resident use stored in a hallway closet and in resident room closets. Continued on next page... Page 2 LPA observed all resident rooms and observed that they contain the required furniture and lighting as outlined in Title 22. Medications, first aid kit, are stored in a locked medication cabinet in the kitchen. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hygiene supplies are in place. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed as current. LPA reviewed staff and resident files on this day. Resident # 5 and #6 physician's report is observed to be out of date with no current assessments or updates on file. Both residents have dementia diagnosis. Staff training records are observed to be current and in place. Administrator certificate for Julita Andaya is observed as expired as of 01/23/2025 but has submitted renewal items and new certification is processing. Report is reviewed with Julita Andaya. A copy of this report is provided to the facility. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Advisory Notes--7 pages--for technical violations to be addressed.the state’s words, verbatim · CDSS document, Apr 22, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Apr 23, 2025

MAINTENANCE AND OPERATION Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This regulation has not been met as evidenced by: Based on observations made, the licensee did not comply with the section cited above, as hot water temperature in clients' bathroom tested at 130 degrees F, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 22, 2025

Plan of correction: Facility shall develop a plan to ensure that the hot water temperature will be lowered and maintained between 105 and 120 degrees. Proof of correction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.695(c) · Plan of correction due date: Apr 29, 2025

§1569.695 (c) Emergency Plans - A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill.This health and safety code has not been met as evicenced by: Based on facility records reviewed, and discussion with administrator, the facility does not have a record of the last emergency drill conducted. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2025

Plan of correction: The facilty shall develop a plan to conduct drills quarterly. This plan and updated disaster drill log is to be maintained at all times. Proof of correction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Apr 29, 2025

87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This regulation has not been met as evidenced by: Based on resident files reviewed, resident #5 and #6 do not have current physicians reports. Both residents reports are over 1 year old with no updated assessments or reports on file. This poses a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2025

Plan of correction: Facility shall ensure that all residents with dementia have either a current physicians report or other assessment showing the resident has no change from last physician's report. Proof of correction to be sent to CCLD BY DUE DATE.

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. Hot water temperature is tested. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 5 residents present, and 2 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. Julita Andaya is a certified RCFE administrator (x 2/25) that oversees facility operations. Client files are reviewed, including medications, which are recorded on Centrally Stored Medications Records. The following forms are requested to be updated and returned to CCL by 4/29/24: • LIC 308 Designation of Administrative Responsibility • LIC 309 Administrative Organization • LIC 500 Personnel Report • LIC 610D Emergency Disaster Plan • Proof of current liability insurance - Infection Control Plan Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Advisory Notes--7 pages--for technical violations to be addressed.the state’s words, verbatim · CDSS document, Apr 22, 2024

The state marks this report as 10 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.