Jazmin Home for the Elderly

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with caregivers that granted entry to the facility and explained the reason for the visit. Caregiver, Estrelita contacted Administrator via phone and later the Administrator joined today’s visit. At approximately 11:30a.m., LPA and Caregiver, Estrelita conducted a physical plant tour inside and out. During the tour, LPA observed that the facility is a home located in a residential community. Required postings were observed in the entry area and hallway. The smoke alarms are operational, located in each bedroom, kitchen and hallways. There is a carbon monoxide detector that functions properly. The fire extinguisher is in the kitchen and office with purchased date of 11/22/2025. During the visit the facility is at 74 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; four (04) hospice waiver. Fire Emergency drill was last conducted on 04/05/2026. The facility is currently occupying six (06) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Kitchen: LPA observed kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrapped and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean Cont. on LIC 809-C Cont. from LIC 809 and inaccessible to pests. Garbage cans have tight fitting covers. Toxic cleaning supplies were stored and locked away in the laundry room closet. Medications: are in a centrally stored and locked medication cabinet in dining area, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the resident’s doctor. First-aid has all proper items and were observed to be stored in a locked cabinet in the dining area. Laundry Room: LPA observed washer and dryer machines located behind the kitchen. Bedrooms: LPA observed six (6) bedrooms designated for residents' and staff use. Bedrooms #1-#4 are for private use, bedroom #5 is a shared and bedroom #6 is staff room. All of the residents bedrooms were properly furnished with appropriate dresser, bedding, and linens with sufficient lighting. Hallways are well lit. Linens are stored in hallway closet and observed to have ample supply of clean linen, comforters, and towels in facility. Bathrooms: LPA observed two (02) bathrooms to be clean, sanitary and with necessary supplies. The appropriate grab bars and mats in the shower. Hot water temperature measured at a range of 106.6°F to 115.4°F and within the required range. Resident’s personal hygiene supplies are kept separate in plastic containers. Towels and washcloths are not shared. Common Areas: These included the dining area and living room for residents. The common areas were properly furnished and observed to be in good repair. Residents dining table fits six (06) residents. No obstructions and/or tripping hazards throughout the facility. There are no issues with Fire Clearance. Surrounding Grounds: Entry and exits were free of obstruction. The facility has appropriate outdoor furniture with a shaded covered area for residents and visitors. The outdoor area was enclosed, and no bodies of water were observed. Garage: The garage stores extra supplies and observed to be locked and inaccessible to residents in care. Staff Files: they have criminal record clearances and are associated to the facility. Staff have current first aid and training documentation showing training completed. Administrator certificate was observed to be current. Resident Records: All six (06) resident records were reviewed. Residents’ records are complete and current at this time. No deficiencies cite during this visit. An exit interview was conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 11, 2026

Type of visit: Required - 1 Year

At 9:45a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with caregivers that granted entry to the facility and explained the reason for the visit. Caregiver, Estrelita contacted Co-Administrator via-phone and later the Co-Administrator joined today’s visit. At approximately 10:15a.m., LPA and Administrator conducted a physical plant tour inside and out. During the tour, LPA observed that the facility is a home located in a residential community. Required postings were observed in the entry area and hallway. The smoke alarms are operational, located in each bedroom, kitchen and hallways. This a carbon monoxide detector that functions properly. The fire extinguisher is in the kitchen and office with purchased date of 11/02/2024. During the visit the facility isat 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; one (1) bedridden; four (4) hospice waiver. Fire Emergency drill was last conducted on 05/05/2025. The facility is currently occupying five (05) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Kitchen: LPA observed kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrapped and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean Cont. on LIC 809-C Cont. from LIC 809 and inaccessible to pests. Garbage cans have tight fitting covers. Toxic cleaning supplies were stored and locked away in the laundry room closet. Medications: are in a centrally stored and locked medication cabinet in dining area, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the resident’s doctor. First-aid has all proper items and were observed to be stored in a locked cabinet in the dining area. Laundry Room: LPA observed a washer and dryer machines located behind to the kitchen. Bedrooms: LPA observed six (6) bedrooms designated for residents' and staff use. Bedrooms #1-#4 are for private used, bedroom #5 is a shared and bedroom #6 is staff room. All of the residents bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Hallways are well lit. Linens are stored in hallway closet and observed to have ample supply of clean linen, comforters, and towels in facility. Bathrooms: LPA observed two (02) bathrooms to be clean, sanitary and with necessary supplies. The appropriate grab bars and mats in the shower. Hot water temperature measured at a range of 108.9°F to 109.4°F and within the required range. Resident’s personal hygiene supplies are kept separate in plastic containers. Towels and washcloths are not shared. Common Areas: These included the dining area and living room for residents. The common areas were properly furnished and observed to be in good repair. Residents dining table fits six (06) residents. No obstructions and/or tripping hazards throughout the facility. There are no issues with Fire Clearance. Surrounding Grounds: Entry and exits were free of obstruction. The facility has appropriate outdoor furniture with a shaded covered area for residents and visitors. The outdoor area was enclosed, and no bodies of water were observed. Garage: The garage stores extra supplies and observed to be locked and inaccessible to residents in care. Staff Files: they have criminal record clearances and are associated to facility. Staff have current first aid and training documentation showing training completed. Administrator's certificate was observed to be current. Resident Records: All five (05) resident records were reviewed. Residents’ records are complete and current at this time. Residents were also interviewed. No deficiencies cite during this visit. An exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. At 10:00 am Estrelita Lim who is the staff met with LPA and was advised regarding the visit. At 10:45AM Evangeline Booth who is the administrator arrived and met with LPA, explained the reason for the visit. At 10:03 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen and office. The charge date is 10/23/2023. During the visit the facility is at 71 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; 1 bedridden; 4 hospice waiver. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the kitchen. Bedrooms: There were six (6) bedrooms designated for residents' and staff use. Room #1, room #2, bedroom #3, and bedroom #4 is for private used, but bedroom #5 is shared. Bedroom #6 is staff room. All of the residents bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are two (2) bathroom designated for residents' and staff use. The bathrooms were properly supplied and had functional fixtures, but very untidy with lime scale and soap scums. Deficiency will be cited on LIC 809-D. Hot water temperature was measured at 110.8 degrees Fahrenheit for bathroom #1 located in the hallway across the dining area. Bathroom #2 is located in between bedroom #4 and bedroom #5. Hot water temperature was measured at 110.1 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were NOT free of obstruction, paints and wood planks were found, deficiency will be issued in LIC 809-D. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage attached and is used for storage. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are NOT being stored in a locked cabinet in the laundry area, deficiency will be cited in LIC 809-D. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is beside the den. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Continue to LIC 809-C Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. Staff medication was kept unlock and accessible to residents. Deficiency will be cited on LIC 809-D. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility. One (1) out of six (6) resident was missing appraisal, citation was cited on LIC 809-D. Planned activities are offered. Records were complete and up-to-date. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, May 28, 2024

Type of visit: Required - 1 Year

On 12/02/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with care staff Esther Lim and explained the purpose of today’s visit. Lim contacted the administrator Evangeline Booth. The facility is licensed to operate for six (6) of (4) may be non-ambulatory elderly residents. The facility is approved for (4) hospice residents. Currently, the facility has (3) residents in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident's rooms, two (2) common bathrooms, a living area, a dining area, a kitchen, and an outside covered patio area. LPA and administrator toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were operational. The water temperature measured 116.0 degree F. A comfortable temperature of 70 degree was maintained in the facility. LPA observed the facility to be clean 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. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was complete and accurate. The facility has conducted a disaster drill on 08/01/23. A landline telephone was in working condition. A review of staff CPR/First Aid training is current. Evaluation Report Continues LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The facility has current liability insurance on file effective 07/06/23 through 07/06/24. The facility is current on Community Care Licensing annual dues. An audit of residents #1-#5 (R1-R5) service files and staff #1-#6 (S1-S6) personnel files revealed to be complete. Interviews conducted with (5) residents and (6) staff were completed. No deficiencies cite during this visit. An exit interview was conducted with Evangeline Booth, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 2, 2023