Jireh Senior Home

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Melisa Rankin and City of Santa Maria Fire Inspector Santos, conducted a Case Management visit to the above facility to check on the Fire Clearance requirements. LPA and Fire Inspector spoke with Licensee Patricia Hernandez. During today’s visit, a tour of the physical plant was conducted and the current approved fire clearance was evaluated for possible changes. Exit interview conducted and a copy of report given.the state’s words, verbatim · CDSS document, May 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 9:04 a.m. to conduct a 1-year annual visit to the facility above. LPA met with Patricia Hernandez and Reyna Espinosa and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility is a 4 bedroom and 2 bathrooms. The facility occupies 4 residents and employs 7 staff of which one is the Administrator. The facility is clean, safe and sanitary. The facility has smoke and carbon monoxide detectors which were tested and working properly at time of inspection. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to residents. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and plenty of shade. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 09/15/26. The facility is approved for a capacity of 6 non-ambulatory and approved for hospice waiver of 3. Staffing, Personnel Records & Training: Staff records are kept confidential. LPA reviewed 5 staff files. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator Certificate expires on 01/01/28. All files were kept up to date with all requirements being met. LPA reviewed staff training records for Annual Training Requirements of 20 plus hours additional training was scheduled and will be completed by end of week. Continued 809-C Resident Records & Incident Reports: The facility keeps separate files on each resident confidential. Four (4) files were reviewed for signed Admission Agreements, Medical Assessments, LIC 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. The facility does not handle cash resources. Incidental Medical & Dental: The facility has a medication that is kept locked. Facility provides or assist in providing transportation to medical and dental appointments when needed. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA reviewed a sampling of residents’ medications, no medications labels were altered, no expired medications, and medications were stored in original containers. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. Kitchen areas are kept clean and free insects and pests. Disaster Preparedness: The current emergency disaster forms were reviewed. The facility conducts quarterly disaster drills. The fire extinguishers were charged last 7/9/25. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were inaccessible to residents in care. The facility does not have delayed egress. The facility does not currently have residents with oxygen. The facility has 1 residents currently on Home Health services. Home Health services records are kept on file. The facility has 2 residents on hospice, all records kept on file. The facility gate is self-latching. The backyard is completely fenced. The facility has exiting door alarms, which were working on LPA's visit. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, May 11, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff are not administering medications as prescribed Staff are not meeting residents personal hygiene needs Staff are not meeting residents nutritional needs Staff violate residents personal rights.

Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Licensee Patricia Hernandez and Back-up Administrator and explained the purpose of the visit. During the initial visit on 8/19/25 LPA toured the facility, interviewed back-up administrator and collected relative documents. During the investigation, LPA conducted an initial visit, interviewed witnesses, and requested additional documentation. On the allegation: Staff violate residents personal rights. It was alleged that residents personal rights were being violated due to a male and female resident are sharing a room. Continue on 9099-C Unsubstantiated LPA toured resident room, there was a room divider, both residents are on Hospice and non-ambulatory. Facility has discussed this with family members and have received signed notices stating representatives are aware and approve of the sharing of the room with the opposite gender. Based on interviews, records and observation, there is insufficient evidence to show that the resident personal rights are being violated. Therefore, at this time, the above allegation is found to be unsubstantiated. On the allegation: Staff are not meeting residents nutritional needs It was alleged that caregivers were instructed by Hospice to increase the thickening of liquids for Resident 1 (R1) to reduce the risk of choking, and to take additional time assisting Resident 2 (R2) during meals to encourage greater food intake. It was further alleged that staff remove food without providing adequate assistance. According to physician documentation, R1 is on a pureed diet. Hospice notes indicate that liquids should be thickened to a “nectar” consistency using 1–2 scoops of thickening agent. The thickening agent is documented on R1’s Centrally Stored Medication and Destruction Record (CSMDR). During the visit, a properly labeled container of thickening agent was observed in the medication storage area. Interview with lead staff, they were able to explain R1’s orders, and preferences. R2 has chopped diet. Hospice notes recommend offering preferred foods frequently and allowing additional time and assistance during meals. Dietician notes confirm that caregivers are following the established care plan for R2. Interview with lead staff, they were able to explain R2’s behaviors, and alternative methods, such as allowing R2 space, then returning to encourage R2 to eat if they had not. A new supportive spoon was introduced and note from hospice agency as of 9/10/25 state R2 is “reported to be doing better since [R2] has had a change in medications and has been able to feed [themselves] more frequently with the use of the adaptive spoon” Based on observation, record reviews and interviews, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Continued on 9099-C On the allegation: Staff are not administering medications as prescribed It was alleged that staff are not administering PRN medications consistently and that when additional PRN was required from the Hospice Nurse, the medications could not be given as staff did not have access. Additionally, due to PRN not given as needed resident became agitated. LPA confirmed during interviews that all staff have the code to the medication cabinet. All staff know they can call the administrator or lead staff to clarify any issues. PRN medications are available on all shifts for any staff to get if they need. All staff were confirmed to have medication training Review of Patient Progress notes left during each visit for R2, reoccurring notes starting 4/28/25 about agitation, sundowning, combativeness, emotional, distressed, disoriented, LPA reviewed notes through October and note that around 7/13/25 notes regarding agitation stopped. Note from hospice agency as of 9/10/25 state R2 is “reported to be doing better since [R2] has had a change in medications and has been able to feed [themselves] more frequently with the use of the adaptive spoon” Medication change was lorasapam which is now s a PRN instead of 3 times a day, and a sleeping medication was introduced which provided R2 more rest. Based on record review and interviews, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. On the allegation: Staff are not meeting residents personal hygiene needs It was alleged that R2 was noted with food particles in facial hair, and same clothing on each visit. During visit, LPA toured facility and observed residents. During visit R1 and R2 had family stop in. Family visited for a while and then pleasantly conversed with caregivers and then left. Residents were observed to be clean, with fresh clothing, there was no odors, or unkept clothing. LPA discussed hygiene and shower schedule with lead caregiver. Continued on 9099-C Discussion with Hospice Administration, review of notes for both residents do not detail any concerns regarding hygiene, or residents being neglected or unkept. Based on observation, record review and interviews, while the allegation may have happened, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, copy of report given.the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 29-AS-20250812151548

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rankin arrived at the facility announced at 7:59 a.m. to conduct a pre-licensing inspection. LPA met with Administrator Patricia Hernandez. This is a change of ownership application from Jireh Senior Home to Jireh Senior Home Corporation. The current census is three (3) residents. The fire clearance was granted on 03/17/25; in which four (4) rooms were cleared for non-ambulatory residents and the master bedroom allows for two (2) bedridden residents. Component III was reviewed for with applicant for reminders and updates as the applicant currently operates a Residential Care Facilities for the Elderly (RCFE)’s in good standing. The LPA toured the physical plant areas, inside and outside, with the applicant to ensure there are no health and safety hazards and to ensure the facility is in compliance with Title 22 Regulations. BEDROOMS: There are four (4) bedrooms in the facility for resident use. Master bedroom has door to the outside, this is the only room approved for bedridden residents. Lighting in the rooms appeared adequate. All rooms were set up with beds, night stands, lamps, chests of drawers, chairs and closet space. BATHROOMS: There is two (2) full bathrooms for resident use. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. All items that could pose a danger were in locked cabinet under sink. Continued on LIC 809-C. COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the back living room area. The facility smoke alarm system was tested and working at time of visit. There is a charged fire extinguisher located in the living room area. Last inspected in July of 2024. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted. All other required postings are also posted in the hall and common areas. KITCHEN: Kitchen knives are stored locked and inaccessible in a cabinet. The supply of perishable and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen are clean and functional. There is an adequate supply of emergency food and water. MEDICATIONS: Medications are in a locked cabinet in the main Livingroom. The first aid supplies were complete. FILES: A sampling of resident and staff records were reviewed and complete. LAUNDRY: The laundry area is located in the attached garage. EXTERIOR: The exterior passageways were clean and clear of any obstructions. The backyard has furniture for resident and visitor use. There are no bodies of water noted on the premises. The back and sides of the house are separated from the front yard by gates. There is a locked shed in the back yard. Facility is in compliance with Title 22 Regulations at this time. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, May 6, 2025

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Change of Ownership Capacity: 6 Census (if any clients in care): 3 COMP II Participants: PATRICIA HERNANDEZ Interview Method: Telephone interview On April 07, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 7, 2025