Jordan Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Vilma Bohanan, administrator for the facility, and explained the purpose of the visit. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a two-story home located in a residential neighborhood. The facility consists of a kitchen, a dining room, a living room, a laundry room, a staff and caregiver bedroom, four (4) resident bedrooms, two bathrooms of which Restroom #1 had a hot water temperature reading of 109.2 Degrees Fahrenheit, and Restroom #2 which had a hot water temperature reading of 111.1 Degrees Fahrenheit., and a detached ADU. Administrator was advised to submit an updated facility sketch to LPA and also associate the family member living in the ADU. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has a fully charged fire extinguisher kept in the facility. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for a capacity of six (6) residents, five (5) of whom may be non-ambulatory, one (1) of whom may be bedridden, and a hospice waiver approved for one (1) resident. · There are two (2) residents, Residents #1 and 2 (R1 and R2) who are listed as bedridden according to their physician’s reports, which exceeds the limit indicated on the license. · Care and supervision to meet the clients’ needs was observed. Staffing: · Five (5) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · All Five (5) staff records reviewed have a health screening with a Tuberculosis clearance, and five (5) staff have First Aid/CPR trainings that are active. · One (1) new staff member Staff #3 (S3) still needs to have their initial 40-hour training conducted and documented by the administrator. · The administrator’s certificate expires on 11/24/2027. Resident Rights/Information: · Physician orders were reviewed for six (6) resident files. · Medications were also reviewed for six (6) residents. · Residents #3 and #4 (R3 and R4) had prescription medications that were not present in the facility. Resident Records/Incident Reports: · Five (5) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, and appraisals were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility. · The last emergency and disaster drill was conducted on 12/30/2025. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs · There is one (1) resident that has half-bed rails on their bed, however they do not have a physician’s order on file. · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit is documented on the LIC809D pages. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 12, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent unannounced Required 1-year annual continuation visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools to complete the annual inspection that was initially conducted on 2/11/2025. LPA met with Vilma Bohanan, administrator for the facility, and was granted entrance. There are five (5) residents residing within the home. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices were observed. · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a two-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, six (6) of which may be non-ambulatory, one (1) of which may be bedridden, and a hospice waiver approved for four (4) residents. The facility consists of a kitchen, a dining room, a living room, a laundry room, one (1) staff bedroom, four (4) resident bedrooms, two (2) bathrooms, and a back yard with pool area. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has two (2) fully charged fire extinguishers in the facility. · Water temperature readings for one of the bathrooms in the home fell within the required range of 105 - 120 degrees Fahrenheit. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for a capacity of six (6) residents, six (6) of which may be non-ambulatory, one (1) of which may be bedridden, and a hospice waiver approved for four (4) residents. · Care and supervision to meet the clients’ needs was observed. Staffing: · Five (5) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · All staff records reviewed have health a health screening with a Tuberculosis clearance, and all staff have First Aid/CPR trainings that are active. · The administrator’s certificate expires on 6/3/2026. Resident Rights/Information: · Physician orders were reviewed for five (5) resident files. · Medications were also reviewed for five (5) residents. Resident Records/Incident Reports: · Five (5) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. · Two (2) residents did not have a completed Pre-Placement Appraisal on file. · Three (3) residents did not have a Reappraisal conducted within the past year. · One (1) resident did not have a completed Physician’s Report (LIC602A) in section thirteen (13). Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan was publicly posted within the facility. · The last emergency and disaster drill was conducted in January of 2025. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs: · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds pages. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced required one-year annual inspection at the facility. LPA met with Vilma Bohanan, administrator for the facility, and explained the purpose of the visit. During today's visit, LPA conducted a tour of the home including the living room, kitchen, laundry room, four (4) resident bedrooms, and two (2) resident restrooms which had a hot water temperatures of 109.3 Degrees Fahrenheit and 106.8 Degrees Fahrenheit. Medications for the residents were also reviewed. During a tour of the backyard area of the facility, the pool area was found to be unlocked and unattended. Due to time constraints, the annual inspection will need to be completed at a later date. The deficiency cited today will be marked on the LIC809D page. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with Administrator, Vilma Bohanan, and explained the purpose for the visit. The fire clearance is approved for (6) non-ambulatory residents, ages 60 and over, of which (1) may be bedridden. There is a hospice waiver approved for 4 residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. Staff are cleaning and disinfecting daily. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. The facility has the sufficient amount for liability insurance covering injury to residents and guests. Physical Plant & Environment Safety: The facility has a swimming pool in the backyard and is surrounded by a locked gate. There are 4 resident bedrooms downstairs, 1 staff room upstairs, 2 communal bathrooms, open living room, dining room, and kitchen. There is a detached garage with a rest area for staff. Facility has an operable smoke detector in each room and a carbon monoxide detector located in the hallway. Knives, cleaning solutions, and disinfectants are locked, making them inaccessible to residents. There are no firearms or weapons stored at the facility. The hot water temperature was measured within the required range of 105-120 degrees F. The fireplace is secured by a fence. Staffing: Per Administrator, she had submitted documents to renew her certificate. LPA verified documents were received and is pending approval. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records-Training: Staff files are maintained at the facility. Staff have current CPR/first aid certificates. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Physician's Report, Pre-admission appraisal, and Resident rights. However, Resident #4, who has dementia, does not have an updated physician's report. Resident Rights-Information: The Complaint poster, Local Ombudsman, and Residents personal rights are posted. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The food are properly stored in the refrigerator. Incidental Medical & Dental: The medications are centrally stored and in their original containers. During the visit today, LPA reviewed all 5 residents' medication and they are being administered as prescribed by the physician. Disaster Preparedness: Facility has an updated Emergency Disaster Plan with contact numbers, at least 2 relocation sites, and emergency procedures. Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. The staff received training to care for residents with dementia and those on hospice. Deficiencies are issued on the LIC809D form. Technical advisories were also provided. An exit interview was held. A copy of this report, technical advisory notes, and appeal rights were given to the Administrator.the state’s words, verbatim · CDSS document, Feb 27, 2024

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.