J.R. Retirement Home for Elderly

Type of visit: Required - 1 Year

At 2:00 PM, Licensing Program Analyst (LPA) Huma Rahimi arrived at the facility above to conduct an annual required visit. LPA was greeted and granted access by staff #1 (S1) EDMIN Bernalledezma. S1 contacted the administrator Jefferson Reyes and informed them LPA was at the facility. LPA explained the reason for the visit. LPA and the Administrator conducted a physical plant tour of the facility and observed the following: Kitchen: The kitchen was observed clean with sufficient supply of two-day perishables and seven-day non-perishables foods. LPA observed the knives and sharp objects located in a locked kitchen cabinet inaccessible to residents in care. Bedrooms: LPA toured four (4) resident bedrooms. Two (2) bedroom may be shared. LPA observed rooms to have appropriate bedding and lighting. There is a night stand and sufficient storage. LPA tested the auditory alarms on the exit doors in the bedrooms and they were observed operational. Bathrooms: LPA toured two resident bathrooms. One (1) bathroom is located in a shared bedroom for private use. All bathrooms were observed with non-skid matts, grab bars, toilet paper, paper towels and hand soap. Hot water temperature was tested at 2:25 PM, and measured at 119.3°F, within regulation. (Continued to LIC809-C) Common Areas: These include living area and dining area. Areas were observed clean and clear of clutter. The facility maintains a comfortable temperature at 76°F. There is a fire place that was adequately screened. There are (2) carbon monoxide detector one (1) in the kitchen and one (1) living area. LPA tested carbon monoxide detector by the living area and observed it operational. There is one fire extinguisher observed fully charged with purchase date 09/26/2025. Auditory alarm on the sliding door leading to the backyard was observed functional. Laundry/Garage: LPA observed chemicals/hazardous items in a locked cabinet in the laundry room inaccessible to residents in care. The laundry room leads to the attached garage that is used to store extra food in a deep freezer and for storage. Outside: LPA toured the outside area of the facility and observed appropriate outdoor furniture, with a covered shaded area for residents. No bodies of water on the premises. Between 2:30 PM to 3:15 PM, LPA reviewed records of five (5) residents and two (2) staff. Residents and staff records appeared to be complete and updated. At 3:16 PM, Administrator tested smoke detectors located throughout the facility. LPA observed smoke detectors to be functioning properly. Medications: At approximately 3:25 PM. LPA reviewed Medication and Medication Records. LPA observed medications locked in a kitchen cabinet. Medications were reviewed for proper storage and documentation. Facility also uses a Medication Administration Record (MAR). LPA conducted a random review of medication for Resident #3 (R3) and observed that the bottle of Clonazepam 1MG started on 04/08/2025 (to present 541 days) with one hundred (100) tablets and the bottle (take one tablet daily) still had twenty three (23) tablets remaining. The Administrator stated that R3 refuses to take medication sometimes; however, no incident report was submitted to the Community Care Licensing nor R3's physician or family was notified. Deficiencies issued during today's visit. Exit interview conducted. Copy of the report provided.the state’s words, verbatim · CDSS document, Oct 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Evelin Rios arrived at the facility above to conduct an annual required visit. LPA was greeted and granted access by staff #1 (S1). S1 contacted the administrator Jefferson Reyes and informed them LPA was at the facility. LPA explained the reason for the visit. Jefferson Reyes arrived at the facility and met with LPA. The facility has an approved fire clearance for five (5) non ambulatory and one (1) bedridden resident for a total capacity of six (6). Facility has a Hospice waiver for two (2). At 9:06 a.m. LPA conducted a tour of the physical plant of the facility inside and out and the following was observed: Kitchen: The kitchen was observed clean with sufficient supply of two-day perishables and seven-day non-perishables foods. LPA observed the knives and sharp objects located in a locked kitchen cabinet inaccessible to residents in care. Common Areas: These include living area and dining area. Areas were observed clean and clear of clutter. The facility maintains a comfortable temperature at 76°F. There is a fire place that was adequately screened. There are (2) carbon monoxide detector one (1) in the kitchen and one (1) living area. LPA tested carbon monoxide detector by the living area at 9:08 a.m. and observed it operational. There is one fire extinguisher observed fully charged with purchase date 10/11/2023. Auditory alarm on the sliding door leading to the backyard was observed functional. Bathrooms: LPA toured two resident bathrooms. One (1) bathroom is located in a shared bedroom for private use. All bathrooms were observed with non-skid matts, grab bars, toilet paper, paper towels and hand soap. Hot water temperature was tested at 9:14 a.m. and measured at 109.3°F, within regulation. (Continued to LIC809-C) Bedrooms: LPA toured four (4) resident bedrooms. Two (2) bedroom may be shared. LPA observed rooms to have appropriate bedding and lighting. There is a night stand and sufficient storage. LPA tested the auditory alarms on the exit doors in the bedrooms and they were observed operational. Laundry/Garage: LPA observed chemicals/hazardous items in a locked cabinet in the laundry room inaccessible to residents in care. The laundry room leads to the attached garage that is used to store extra food in a deep freezer and for storage. Outside: LPA toured the outside area of the facility and observed appropriate outdoor furniture, with a covered shaded area for residents. No bodies of water on the premises. Resident and Staff Files: At approximately 9:40 a.m. LPA reviewed resident files. LPA conducted a file review of five (5) out of five (5) resident records to insure compliance of licensing forms. LPA observed half bed rails on resident #1's(R1's) bed and resident #2's(R2's) bed. LPA's review of R1 and R2's file revealed there is no written bed rail order from a doctor on file for both residents. At 10:18 a.m. LPA also conducted a file review of three (3) staff records to insure forms and training are up to date and in compliance with licensing forms. LPA reviewed emergency disaster training, LIC 500 and infection control plan. LPA discussed resident care plans with administrator. At 10:45 a.m. administrator tested smoke detectors located throughout the facility. LPA observed smoke detectors to be functioning properly. Medications: At approximately 10:50 a.m. LPA reviewed Medication and Medication Records. LPA observed medications locked in a kitchen cabinet. Medications were reviewed for proper storage and documentation. Facility also uses a Medication Administration Record (MAR). Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, there was a deficiency observed during today's visit (refer to LIC809-D). Exit interview conducted. Appeal rights and copy of the report provided.the state’s words, verbatim · CDSS document, Oct 4, 2024