Jcp Cottage

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Staff, Jusuf Audhy Dajoh and introduced self and stated the purpose of the visit. Audhy notified the Licensee, Sevi Turangan over the phone about the LPA's purpose of the visit and Licensee arrived shortly after. The facility has 6 bedrooms, 2 bathrooms, kitchen, dining area, living room, laundry, backyard, and attached garage. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 78 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms appliances were found functional. Water temperatures tested at 109 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, charged fire extinguisher and first aid kit. Posters such as; the personal rights, emergency disaster plan, CCL complaint poster and ombudsman were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept locked and inaccessible to residents. There was a designated storage space for resident/staff files. Medications was observed locked and inaccessible to residents. There is no swimming pool, bodies of water, firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for residents in care. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, side gate with self-latching handle on the left and right side of the house that leads into the backyard and one shed used for storage. Record Review: LPA reviewed all resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed that the residents appraisals have not been reviewed/updated annually. Technical violation issued. LPA observed that a bedridden resident was placed in a nonambulatory bedroom. Deficiency with civil penalty issued. LPA also reviewed personnel and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed that the only staff present upon arrival had an expired CPR certification. Deficiency issued. Medications were audited at random and discrepancies were found. LPA observed that the medication log was not updated with the correct medications and dispensing initials were missing. Deficiency issued. LPA reviewed the facility's insurance coverage, emergency disaster plan, infection control plan and emergency drills. LPA observed that the infection control plan was not reviewed/updated annually. Deficiency issued. LPA observed that the emergency disaster plan was not reviewed/updated since 11/5/24. Deficiency issued. LPA observed that the facility did not have emergency kits. Deficiency issued. LPA observed that the facility is not maintaining proof of the quarterly drills before October 2025. Deficiency issued. Deficiencies, technical violation and one civil penalty were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV, LIC421IM and appeal rights were discussed and copies were provided to Licensee, Sevi Turangan.the state’s words, verbatim · CDSS document, Nov 7, 2025

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Staff, Arie Makarawung and introduced self and stated the purpose of the visit. Arie notified the Licensee, Sevi Turangan over the phone about the LPA's purpose of the visit. LPA was informed that there are currently 5 residents in care. The facility has 6 bedrooms, 2 bathrooms, kitchen, dining area, living room, laundry, backyard, and attached garage. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 77 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms appliances were found functional. LPA observed a broken mirror in the hallway bathroom, a dirty bathtub and sink in the bathroom of the master bedroom and a broken side gate door on the left side of the backyard. Deficiency issued. LPA observed that the master bathroom did not have a non-skid mat in the bathtub. Deficiency issued. LPA observed a staff assist a resident in the bathroom with the door left opened. Deficiency issued. Water temperatures tested at 107.2 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, charged fire extinguisher and first aid kit. Posters such as; the personal rights, emergency disaster plan, CCL complaint poster and ombudsman were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept locked and inaccessible to residents. LPA observed a cleaning product made accessible to residents inside the master bedroom bathroom and the magnetic key left accessible in the kitchen cabinet. Deficiency issued. There was a designated storage space for resident/staff files. Medications was observed locked and inaccessible to residents. There is no swimming pool, bodies of water, firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for residents in care. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, side gate with self-latching handle on the left and right side of the house that leads into the backyard and one shed used for storage. Record Review: LPA reviewed staff and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed a health screening missing the physical clearance, doctor's signature and stamp. Deficiency issued. LPA observed a staff assist a resident from the bathroom without background clearance. Deficiency with civil penalty issued. LPA observed that a staff member had background clearance and was removed from facility association. Technical violation issued. LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed one resident's admission agreement printed on double sided. Technical violation issued. LPA observed that the facility did not have an Infection Control Plan available for review. Deficiency issued. LPA observed that the facility did not have proof of liability insurance. Deficiency issued. LPA observed that the facility did not have a record of emergency drills. Deficiency issued. LPA observed that the facility did not review/update the emergency disaster plan since 10/19/21. Deficiency issued. Deficiencies, technical violations and one civil penalty were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV. LIC421BG and appeal rights were discussed and copies were provided to Licensee, Sevi Turangan.the state’s words, verbatim · CDSS document, Nov 5, 2024

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 11/07/23, Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Administrator, Frisco Sanry and introduced self and stated purpose of the visit. LPA was informed that there are currently 4 residents in care. The facility has 6 bedrooms, 2 bathrooms, kitchen, dining area, living room, laundry, backyard, and attached garage. LPA completed a walk through of facility and review of records. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 105.3 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, charged fire extinguisher and first aid kit. Posters such as; the personal rights, emergency disaster plan, CCL complaint poster and ombudsman were posted in a common area. LPA observed an outdated emergency disaster plan last reviewed on 10/19/2021. Technical violation issued. Cleaning supplies, toxins, sharps, and other dangerous items were kept locked and inaccessible to residents. There was a designated storage space for resident/staff files. Medications was observed locked and inaccessible to residents. There is no swimming pool, bodies of water, firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for residents in care. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, side gate with self-latching handle on the left and right side of the house that leads into the backyard and one shed used for storage. Record Review: LPA reviewed staff and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed incomplete files for residents. Deficiency issued. LPA observed that the facility did not have an updated infection control plan. Deficiency issued. LPA observed that the facility does not maintain a log for the emergency drills performed. Deficiency issued. Deficiencies and one technical violation were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV and appeal rights were discussed and copies were provided to Administrator, Frisco Sanry.the state’s words, verbatim · CDSS document, Nov 7, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.