Jordeth Senior Care Home

Type of visit: Required - 1 Year

On 07/24/26 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Licensee/Administrator, Davilyn Mancilla explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 2 residents present during time of visit. Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Carbon monoxide detector was present and operational at time of visit. Fire extinguisher last serviced 07/20/2026. Last fire drill on conducted on 07/06/2026. Resident rooms observed to have the required furnishings and with adequate lighting. LPA observed sufficient seating under covered patio areas. The following issues were observed during today’s visit: Facility was having work done to the roof and CCL was not notified. 1 of 1 staff file reviewed did not have the required annual training completed. Facility sketch does not identify assembly points/points. Transportation needs and evacuation procedures are not appropriately reflected. Process for communicating with others is not listed. Annual training on plan is not completed. Deficiencies cited per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809D. If not corrected, the violation with have a direct risk to the health, safety and/or personal rights of residents in care. LPA requested the following documents to be submitted to CCL by 08/07/26: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020), and a current copy of liability insurance in order to update the facility file. Exit interview was conducted with Licensee/Administrator. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided to Administrator.the state’s words, verbatim · CDSS document, Jul 24, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst LPA Shawna Doucette conducted an Annual Inspection on this date. LPA was met by Administrator Davilyn Mancilla and discussed the purpose of the visit. LPA and Administrator began the tour at the front entrance of the facility A tour of the facility was conducted with the Administrator. The residence was set at 78 F temperature and free of passageway obstructions outside. Staff room bed was blocking door to enter the room that leads to a fire exit in the garage. LPA had to turn sideways to enter the room. Facility sketch lists staff room as a fire exit to the garage. Resident rooms were clean. Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked cabinet in the kitchen/Dining area. Cleaning supplies were locked in a cabinet in the garage. Smoke detectors and carbon monoxide detectors were checked and operating. Facility has a pull station fire alarm. Fire drill was last conducted 7/10/25. Resident, medication and staff records were reviewed. Current first aid and CPR were reviewed. R1, R2 and R3 did not have Hospice Care Plans. A copy of this report with plans of correction with appeal rights were provided to Administrator. Civil penalty was issued for fire clearance.the state’s words, verbatim · CDSS document, Aug 2, 2025

Type of visit: Required - 1 Year

Today, Licensing Program Analyst L. Xiong arrived at the facility unannounced to conduct the Annual Inspection. LPA met with Administrator/Licensee Davilyn Mancilla and inform her the purpose of the visit. LPA toured the facility with Licensee. Facility appeared clean with no obstruction or fire clearance issues. All common areas have adequate seating and lighting. Resident bedrooms toured, rooms observed to have all required accommodations. Kitchen toured, LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available for residents. Smoke detector and carbon monoxide detectors observed operational during inspection. Fire extinguisher present with a service date of 07/2024. Water temperature observed to measure at 105 degrees F. No deficiencies were observed.the state’s words, verbatim · CDSS document, Jul 23, 2024