Jefferson Manor

Type of visit: Required - 1 Year

On 11/07/2025, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Czarina Serrano the Administrator. LPA explained the purpose of today’s visit. The facility is a one-story Residential Care Facility for the Elderly (RCFE) home, licensed to serve dementia adults aged 60 and above of which (1) can be non-ambulatory and (3) ambulatory. The facility has no approved hospice waiver, and currently the facility has (4) residents. The facility features approximately (4) bedrooms and (2) bathrooms. The facility has a kitchen, a dining area, living room, an outside patio area, an attached storage area, an unattached laundry room containing a refrigerator with extra food supplies located at the back of the facility. LPA Watson and the Administrator Serrano toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (4) bedrooms and (2) bathrooms. All residents’ rooms were inspected. Mattresses linen and box springs were inspected and observed to have mattress covers, clean and free from infestation. Bed linens, comforters and bath towels were adequately stocked at the time of visit. The first aid kit was checked and fully stocked with tweezers, tape, gauze, Band-Aid's, thermometer and certified manual. The evaluation Report continues the next page, LIC 809-C, providing further details of the inspection findings. The bathrooms were inspected, toilets and water faucets worked properly, and showers were free of mold and mildew. Each resident’s room contained a chair, lamp, drawer, dresser, and plenty of closet space. There is adequate lighting in the hallway, including a night light and sufficient toiletries are available for the residents. The beds and bedding supplies were in good condition, adequate lighting was provided in each room, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. The facilities (8) Smoke / Carbon monoxide detectors were in operable condition. The water temperature ranged from 107.5 °F in the kitchen and between (118.7 °F in bathroom #1 and 118.8 °F and in bathroom#2) the room temperatures ranged from 72.6 °F to 73.1°F. During the visit, LPA Watson observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were locked up in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All (3) fire extinguishers were charged and operable. The last Fire / Disaster Drill, according to facility records, were conducted on 04/25/25. The department conducted a review of (4) residents' service files and (1) staff personnel file. LPA reviewed (4) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of the facilities liability insurance was current and showed an expiration date of 03/26/2026. Facility Annual Fees were current. An exit interview was conducted with the Administrator Czarina Serrano, and a copy of the Facility Evaluation Report was provided to the facility.the state’s words, verbatim · CDSS document, Nov 7, 2025

Type of visit: Case Management - Other

On 10/22/2025, Licensing Program Analyst (LPA) Troy Watson arrived at the facility listed above to conduct an unannounced Case Management-Other visit to follow up on a facility fire incident. LPA met with the Care Giver Irene Leonor and explained the purpose of the visit. LPA Watson conducted a case management visit to gather information on a fire that occurred on the premises of the above listed facility on 10/17/25 at approximately 7:00PM. According to information reported on an Unusual Incident Report the fire only caused damage to an unattached storage unit located in the back of the facility. The Case Management visit consisted of: On 10/22/25, LPA requested, obtained and reviewed the following: Staff Schedule, Resident Roster, Unusual Incident Report and the Los Angeles Fire Department Public Fire Report, (LAFD) Public Fire Report. On 10/22/25, LPA conducted interviews with Staff#1 – Staff#2 (S1-S2). CONTINUED ON LIC9099-C On 10/22/25, LPA Watson interviewed Staff#1 – Staff#2 (S1-S2) about the fire incident that occurred at the facility listed above. Out of those interviewed both confirmed that no injuries to residents because of the fire. The administrator stated that a staff member called 911 at approximately 7:00PM. The responding fire department was Station #26 who responded to a call at approximately 6:50 PM on 10/17/25. The administrator explained that the residents responded to the smoke alarms that sounded off in the main building and evacuated to the front of the residence according to their fire drill training. After evacuation was completed, all residents inspected were without any injuries. According to staff interviews the fire to the storage unit was extinguished by the Fire Department within minutes. LPA Watson took photos of the fire and smoke damage to the storage unit and the debris that resulted from the fire incident. According to the Licensee The Los Angeles Fire Department Captain Balestra has stated that the cause of the fire is unknown. An exit interview was conducted with the Licensee and a copy of this report was given to the facility.the state’s words, verbatim · CDSS document, Oct 22, 2025

Type of visit: Required - 1 Year

On 09/30/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Caregiver, Irene Leonor, and explained the purpose of today’s visit. Facility’s Administrator, Czarina Serrano, later joined LPA for the inspection. The facility is licensed to operate for six (6) elderly adults ages 60 and above. Four (4) ambulatory, and two (2) non-ambulatory. Currently there are three (3) residents in the facility. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four bedrooms, two (2) bathrooms, a living room, dining room, kitchen, behind the home there is an office, bathroom, staff room and a laundry area. LPA and Czarina Serrano toured the inside and out of the physical plant. There were no bodies of water or obstructions on the premises. Exits/ Walkways around the facility were free of debris and hazards. All resident rooms were inspected. Bedrooms had the required furniture and in good condition, adequate lighting was observed, and sufficient closet/drawer space to accommodate the client comfortably. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were clean and operational and found to be within Title 22 regulations. The water temperature properly measured between 105.0 F and 120.0 F. A comfortable temperature was maintained in the facility. The kitchen was inspected and there is sufficient perishable and non-perishable food supply and maintained adequately. Sharps, toxins, cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors and carbon monoxide were tested and are working properly. Fire extinguishers were fully charged. A stocked First Aid kit along with manual was available. A review of (3) resident service files and (3) staff personnel files was maintained in order. LPA reviewed (3) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. LPA did not observe any deficiencies; therefore, no citations were issued at this time. An exit interview was conducted, and a copy of the report was provided to Czarina Serrano, Administrator.the state’s words, verbatim · CDSS document, Sep 30, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1- year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met Assistant Administrator Chilly Navarro and staff Mark Leonor and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved mitigation plan report. There are currently four (4) South Central Los Angeles Regional Center residents in placement. The facility's annual fees are current. 12 Domains in the Infection Control Practices will be observed and reviewed. "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections." The facility is a single-story family home located in a residential neighborhood with, a living room, dining area, kitchen, 4 bedrooms, 2 bathrooms, an outside laundry room, and an indoor/outdoor activity area. A shaded area with outdoor patio furniture, table, and chairs. Bedrooms #1-4 are designated as the resident's bedrooms. During the tour, LPA Bunker observed sanitizer, visitor log, and thermometer at the facility entrance. Logs of daily COVID-19 screening and temperature checks of clients and staff were available and updated. PPE supplies are readily available to staff, and an additional supply of PPE was observed. sufficient liquid soap, paper goods, cleaning, and disinfecting supplies were observed. LPA observed staff and residents wearing a face covering and social distancing. See continued LIC809-C page 2 Continued LIC809-C page 2 Documents have been diligently posted as mandated on the wall in the kitchen and breakfast area. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture, and bathrooms are clean and operational. Personal accommodations were observed for safety, privacy, and comfort, including the provision of non-skid surface mats. The kitchen was observed for its ability to prepare and serve food. The food service was reviewed for appropriate quantity and proper storage; there was an ample supply of perishable and nonperishable food. The resident’s medications were reviewed for proper storage, documentation, and system implementation. Medications are securely locked, and records are current and up to date. Common areas observed for the ability to safely serve the needs of the residents, including cleanliness, and clear of any potential hazards to the residents. The first aid kit is fully stocked with manual, smoke, and carbon monoxide detectors were in compliance, the hot water temperature was measured within normal limits at 120 degrees Fahrenheit (within the range of 105-120 degrees Fahrenheit). The fire extinguisher is fully charged, adequate linen supply, and the facility's telephones are tested and found to be in working order, The client's bedroom windows have no sliding window lock with thumbscrews, all exit doors were found to be in compliance, the yard was free of debris hazards, and trash cans were covered. Staff members have undergone training on reporting dependent adult and elder abuse. The facility conducted a fire drill on September 18, 2023. There were no deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Oct 4, 2023