K & J Residential Care Home-Hayward

Type of visit: Required - 1 Year

On this day, January 14, 2026, at 10:20 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Elton Brown, administrator (ADM), and informed the reason for visit. Ester Ramirez, assistant administrator (AADM) arrived after few minutes. LPA started the inspection with ADM and continued with AADM. LPA inspected the facility inside out. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has 2 in 1 smoke and carbon monoxide detectors that were tested, and observed in operating condition on this day. Hot water temperature in one of the bathrooms was tested. Facility conducts disaster drills at least every quarter and records showed last conducted November 17, 2025. LPA reviewed 3 residents and 5 staff files. Residents medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 10:20 a.m., gardening spray, gallon of paint in the front yard. -at 10:30 a.m., floor cleaning spray in the backyard. .......continued on 809C CONTINUATION FROM PAGE 1: -at 10:35 a.m., hot water at 124 degrees Fahrenheit. LPA received current/updated copies of the following: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M liability insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809D. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof of corrections were discussed with ADM and AADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: Required - 1 Year

On this day, February 26, 2025, at 12:50 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Caprisha Twine, and informed the reason for visit. LPA called and spoke over the phone with Elton Brown, administrator (ADM). ADM arrived at around 1:05 pm followed by Ester Ramirez, assistant administrator (AADM). LPA started the inspection with Caprisha Twine and continued with ADM and AADM. LPA inspected the facility inside out. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has 2 in 1 smoke and carbon monoxide detectors that were tested, and observed functional. Hot water temperature in one of the bathrooms was tested, and measured at 115 degrees Fahrenheit. Facility conducts disaster drills at least every quarter and records showed last conducted 12/03/24. LPA reviewed 4 residents and 4 staff files. Residents medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 1:01 pm, rotten lettuce, zucchini with mold, expired bacon bits (expiration: 2022) and parmesan cheese (expiration: 2022). -at 1:10 pm, paint in the backyard. -at 1:18 pm, peritoneal cleanser, Cortizone ointment in a closet without lock. .......continued on 809C -at 3:50 pm, 2 of resident's (R1) medications not recorded on LIC622. Administrator to submit updated/current copies of the following by March 12, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. Proof of $3M liability insurance Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof of corrections were discussed with ADM and AADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Feb 26, 2025

Type of visit: Case Management - Annual Continuation

At 10:40 am on this day, February 9, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual required inspection that was started on January 15, 2024. LPA was granted entry by Ester Ramirez, care staff. LPA met with Elton Brown, administrator, and informed the reason for visit. LPA reviewed 5 resident records and interview 2 residents. LPA inspected the medications. compared with doctor's order on file and LIC622 Centrally Stored Medication and Destruction Records and Medication Administration Record (MAR). LPA observed the following: -at 11:10 a.m. to 11:20 a.m., residents (R1 and R2) LIC602A Physician's Reports were over a year old. -at 11:30 a.m., residents (R1 and R5) half bed rails have no doctor's order on file. -at 11:40 a.m. R1's LIC625 Appraisal/Needs and Service Plan is over a year old. -at 11:55 a.m., resident (R5) LIC9172 Functional Capability Assessment has contradicting information on eating and repositioning. -at 12:10 p.m,, R1 has 15 medications listed on the doctor's order on file; however, R1 has only 7 medications on facility's hand, one of which not on the order. -at 12:30 p.m., most current order of medications for R2 does not have dosage; Baclofen dosage from April 11, 2023 order is not consistent with what the facility has on hand. One medication on the current list but facility does not have the medication -at 1:15 p.m., R3's medications order on file for 17 meds but facility only has 11 on hand. Order for Vit D3 is 50 mcg 1 tablet per day, and on facility's hand is 25 mcg and facility administers only 1 tablet per day. ....continued on 809C Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator. Administrator has to leave the facility, and authorized Ester Ramirez to sign and receive this report. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Feb 9, 2024

Type of visit: Required - 1 Year

On this day, January 25, 2024, at 2:35 p.m, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Elton Brown, administrator, and Ester Ramirez, staff. and informed the reason for visit. Facility has Infection Control Plan that was submitted and received by LPA on 1/23/24. LPA toured the facility inside out with the administrator. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has 2 in 1 smoke and carbon monoxide detectors that were tested, and observed functional. Hot water temperature in one of the bathrooms was tested. LPA reviewed 2 staff files and interviewed 2 staff. ...continued on 809C LPA observed the following: -at 3:02 p.m, bleach, extra strength dishwashing liquid and Fabuloso multi-purpose cleaner in unlocked kitchen cabinet under the sink. -at 3:05 p.m., knives and peelers in kitchen cabinet without lock. -at 3:11 p.m., hot water temperature at 121 degrees Fahrenheit. -at 3:22 p.m., rubbing alcohol and athlete's foot ointment in one of the resident rooms. -at 4:00 p.m., no disaster drill records. According to the administrator they conducted drills 2x since facility was licensed but didn't keep record. -at 5:00 p.m. to 5:20 pm., staff (S1 and S3) have no LIC501 Personnel Record, LIC503 Health Screening & TB test records on file -at 5:20 p.m., S3 who according to administrator started working 1/02/24 and have been working independently with residents, have not completed the required initial 20 hrs of training. S3 has only have 3,5 hours dementia training. -at 5:15 p.m, S2 has no LIC503 on file. Administrator to submit the following updated/current documents by February 8, 2024: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Jan 25, 2024