Jensteph Home Care

Type of visit: Annual/Random

At approximately 9:35 AM Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a Required- 1 Year visit, and met with caregiver Violeta Navarro who has Designation of Facility Responsibility (RP). RP called Licensees Rose Aquino, and Administrator Rafael Aquino who arrived at approximately 10:00 AM to further assist with today's required inspection. There are currently are four (4) residents in care. LPA observed two caregivers on duty upon admission into the facility. Fire clearance approval is for six (6) non-ambulatory residents, there is no bedridden approval. Facility has an approved hospice waiver for one (1). Facility has an approved dementia plan of operation. Facility has a required infection control plan. Facility has an emergency disaster plan as required. LPA toured the facility with Administrator Rafael. Facility was observed to clean, orderly and without odors. All postings were visible to all entering facility. Hot water was measured at 115.7. degrees Fahrenheit. All bathrooms had grab bars, and shower mats/non-slip flooring for resident use. Fire extinguisher was serviced and tagged as required on 04/2026. All exits were clear and free from obstruction. The bathrooms, resident rooms, hallways, and all common areas had sufficient lighting for residents' in care, and for use by residents. Facility had sufficient furnishings for resident use. Backyard was free and clear of any hazards, and backyard fire exit path was clear and free of obstruction. The backyard features a shaded patio and furniture for residents' use. In addition facility has two thriving covered and exposed gardens. Two sheds were opened to reveal hardware and toxins locked up. Exit doors had auditory alarms. Continued on LIC809C.. Continued from LIC809 Food supply was sufficient and facility has a wide variety of fresh and frozen foods that are stored well. Facility had sufficient supply of cleaners, paper products, linens. and personal protective equipment (PPE). LPA reviewed four (4) resident files and found all 4 needed updated Appraisal and Service Needs (ANS) plans for Residents R1, R2, R3 and R4 and a Technical Violation for violation of CCR 87463(a) which requires annual updates to ANS for residents. LPA reviewed four (4) staff files. All staff had required criminal record clearance. LPA notes that both primary care staff (S1 and S2) did not have evidence of current CPR training and a Type B citation for violation HSC 1569.618(c)(3) is cited, which requires that the facility have a caregiver with current CPR training on-site at all times. Medicines were observed to be centrally stored and secure. Facility does not manage Resident Cash Resources. LPA requested the following documents be updated and submitted to CCL by 10/01/2026: LIC500 - Personnel Report LIC610 (9 pages) - Emergency Disaster Plan- if updates, submit copy to CCL LIC9020 Roster of residents Copy of Current Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator Rafael Aquino. Appeal Rights provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 1, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.618(c)(3) · Plan of correction due date: Sep 11, 2026

(c)The facility shall employ, and the administrator shall...(3)Ensure that at least one staff member who has CPR training and first aide training is on duty and on the premises at all times. This paragraph shall not construed to require staff to provide CPRthe state’s words, verbatim · CDSS document, Sep 1, 2026

Plan of correction: Licensee to self-certify they have read regulation HSC 1569.618(c)(3) and to provide proof of appointments for CPR training and/or valid CPR certificates for ALL for staff members by 09/11/2026.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 8/13/25 at approximately 10:25am, and met with Licensee Rose Aquino, and Administrator Rafael Aquino. There currently are five (5) residents in care. LPA observed two caregivers on duty upon admission into the facility. Fire clearance approval is for six (6) non-ambulatory residents, there is no bedridden approval. Facility has an approved hospice waiver for one (1). Facility has an approved dementia plan of operation. Facility has a required infection control plan. Facility has an emergency disaster plan as required. LPA reviewed five (5) resident files. Files were complete. LPA reviewed four (4) staff files. All staff had required criminal record clearance. Staff had required first aid certification and CPR certification, per file reviews. LPA toured the facility with Administrator Rafael. Facility was observed to clean and orderly. All postings were visible to all entering facility. Hot water was measured at 113. degrees Fahrenheit. All bathrooms had grab bars, and shower mats/non-slip flooring for resident use. Fire extinguisher was serviced and tagged as required. All exits were clear and free from obstruction. The bathrooms, resident rooms, hallways, and all common areas had sufficient lighting for residents' in care, and for use by residents. Facility had sufficient furnishings for resident use.Backyard was free and clear of any hazards, and backyard fire exit path was clear and free of obstruction. The backyard had patio furniture for residents' use. Exit doors had auditory alarms. Food supply was sufficient. Facility had sufficient supply of cleaners, paper products, linens. and personal protective equipment (PPE). Continued on LIC809C.. Continued from LIC809, dated 8/13/2025... LPA requested the following documents be updated and submitted to CCL by 9/13/2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 (9 pages) - Emergency Disaster Plan- if updates, submit copy to CCL Infection Control Plan- if updates, submit copy to CCL Copy of LIC400 Handling of Client Cash Resources- complete & submit (all facilities complete form) Copy of Surety Bond- if handling cash Copy of Current Liability Insurance Roster of residents Copy of current Administrator Certificate Deficiencies observed by the LPA during inspection. Staff S3 and S4, who are direct caregivers, lacked proof of required annual training, per file reviews. This deficiency will be cited, HSC 1569.625(b)(2) Staff training; legislative findings; contents - In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training, see LIC809D. Staff S3 and S4, who assist residents with medications, lacked proof of required medication training, per file reviews. This deficiency will be cited, HSC 1569.69 (b) -Employees assisting residents with self-administration of medication; training requirements. Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator Rafael Aquino. Appeal Rights provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Required - 1 Year inspection and met with Administrator/Licensee, Rafael and Rose Aquino. There are currently 5 residents in care. There were 2 staff at the time of inspection. This facility is licensed for 6 non-ambulatory residents, with hospice waiver approved for 1 of the resident and none of the residents are approved for bedridden. LPA toured facility and grounds and observed the home organized and at a comfortable temperature with all exits free from obstruction. Exit doors have auditory alarms to alert staff. The fire extinguisher located in the kitchen was observed charged and serviced on 09/10/2024. Fire drills have not been documented. LPA requested Fire Drill to be conducted and proof sent to CCL. Water temperature in the resident bathroom was tested and found to be within appropriate range of 105-120 degrees. Bathrooms have required non-skid surfaces and grab bars. Cleaning products and knives are stored in locked cabinets in the kitchen and the laundry room. There was a 7 day supply of non-perishable foods. There are adequate dishes, glasses and silverware. Residents' medications are stored locked. Resident and staff files are located and locked in cabinet. LPA reviewed staff files and staff have proof of CPR/1st aid. LPA requested proof of yearly training. Resident files were reviewed and found to be complete, except for Consent for Medical Treatment. LPA left copies for each resident/DPOA to complete. Continued on 809-C Continued from 809 Licensee/Administrator to submit the following documents by 10/10/24: · LIC 500 Personnel Report · Proof of Staff Trainings · Copy of Liability Insurance and Documentation of Emergency Drills No citations issued at this time.the state’s words, verbatim · CDSS document, Sep 17, 2024

Allegation investigated: Facility not following Hospice Care Plan Resident left in soiled bedding for long periods of time Staff verbally abusing resident Facility not following physician orders

Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. Based upon interviews, site visits, and document reviews, the following determinations are made: Staff state no Hospice Care Plan was left at facility until after January 18; LPA noted no Hospice Plan at facility on Jan. 18; Hospice management state a care plan was left in November, 2023; Following site visit of Jan 18, LPA advised Hospice that no care plan was at facility; LPA noted care plan at facility on subsequent site visit of Jan 23; Complainant has not personally observed Resident (R1) but has suggested several witnesses to R1's neglect; Only one witness( W1) has responded to this Department's request for a statement and W1's statement does not support the allegations of neglect; R1 and R1's bed were clean at three LPA unannounced visits; Facility staff did not document administrations of PRN medication ordered by physician but state that PRN medications were administered according to the physician's orders. Although the allegations may be true, based upon statements, documents, site visits, there is not a preponderance of evidence to prove, or disprove, the allegations. Therefore, allegations are UNSUBSTANTIATED. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 15, 2024 · control 21-AS-20240111095624

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Feb 29, 2024

87465(h)(6) Incidental Dental and Medical Care. The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year…: Based on document review, this requirement not met as evidenced by: Antibiotic ordered for R1 was not documents on the Centrally Stored Medication log. This posed a potential risk to the health of R1.the state’s words, verbatim · CDSS document, Feb 15, 2024

Plan of correction: Administration shall provide refresher training on Medications for all staff handling and administering medication and provide proof of training to CCL by POC date in order to clear the deficiency.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst Leibert arrives unannounced following a complaint investigation which resulted in LPA noting some deficiencies that were not enumerated in the complaint allegations. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. Report Left.the state’s words, verbatim · CDSS document, Feb 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87625(b)(3) · Plan of correction due date: Feb 22, 2024

87625(b)(3) Managed Incontinence. ..The Licensee shall be responsible for…ensuring that incontinent residents are kept clean and dry..***Based on statement and observation, this requirement not met as evidenced by: On 1/23/24 LPA observed R1 had not been changed at 9:45 am when other residents present were changed at 6 am. Staff stated that Hospice aid would change R1 when aid arrives. This posed an immediate violation of R1 personal rights and risk to health.the state’s words, verbatim · CDSS document, Feb 15, 2024

Plan of correction: Administrator to provide refresher training to caregivers on the requirements of 87625 and will submit proof of training to CCL by POC date in order to clear the deficiency.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(C)(3) · Plan of correction due date: Feb 29, 2024

87465(C)(3) Incidental Dental and Medical Care. A record of each dose (of PRN medication) is maintained in the resident's record. *** Based on observation and statements, this requirement has not been met as evidenced by: On 1/18/2024, LPA noted that there was no record of PRN medications administered to R1 and that staff stated PRN meds were administered but not recorded. This posed a potential risk to the health of R1.the state’s words, verbatim · CDSS document, Feb 15, 2024

Plan of correction: Administrator will provide refresher training to caregivers regarding the requirements of 87465 and will submit proof of training to CCL by POC date in order to clear the deficiency.