Kazlin Infinite Care

Type of visit: Required - 1 Year

On 08/27/2025, Licensing Program Analyst (LPA) V Gorban arrived unannounced to conduct Required Annual Inspection. LPA met with staff Maria Flores. Administrator (AD) Jasmin Burns was notified and was able to attend the visit. LPA conducted facility tour inside and out of facility with staff. Residents observed at the facility before lunch time. The facility was observed to be at a comfortable temperature of 75 degrees, clean, in good repair, and no passageway obstructions or fire hazards observed. Fire extinguisher was observed with a service date of 05/01/2025. Recent fire drill recorded on July 2025 Dining area and Kitchen were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer, refrigerator, and pantry. Food is delivered once a week. The facility is comprised of single level home. The census during the visit was four residents. Hot water temperature tested at 104 degrees F. LPA observed securely fastened grab bar and non-skid mat in shower area. The facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents. Facility phone number observed operational 209-349-8457 Medications were stored in a locked medication closet in a common area. The first Aid Kit was observed with all required items. LPA reviewed facility Plan of Operation, Infection Control Plan, Emergency Disaster Plan and number of staff and residents’ files requested and reviewed during the inspection visit. Deficiency cited on attached LIC9099-D Exit interview conducted, report signed and provided with appeal rightsthe state’s words, verbatim · CDSS document, Aug 27, 2025

Allegation investigated: Neglect/Lack of Care and/or Supervision resulting in violation of a resident's personal rights

On 03/05/2025, Licensing Program Analyst (LPA) V Gorban arrived unannounced to commence complaint investigation on the above allegation. LPA introduced self, stated the purpose of the visit and met with house manager Maria Flores, administrator was notified but was not able to attend the visit. Allegation: Neglect/Lack of Care and/or Supervision resulting in violation of a resident's personal rights During the course of the investigation, records were received and reviewed, staff and residents interviews were conducted, and facility was toured. Residents and staff interviewed denied neglect, lack of care and supervision. Based on records review and interviews conducted, there was insufficient evidence to prove or disprove neglect , lack of care and supervision resulting in violation of a resident's personal rights. Therefore, preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBSTANTIATED. Exit interview was conducted. A copy of this report was provided to house manager, whose signature on this form confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 5, 2025 · control 24-AS-20250225131354

Type of visit: Case Management - Health Checks

On 03/05/2025, On 08/08/2024 Licensing Program Analyst (LPA) V Gorban visited the facility stated above to conduct case management. This visit resulted in regard to complaint investigation and file review During this visit LPA conducted safety check by touring the facility and observing and interviewed clients in care, interviewed staff, administrator and reviewed facility files. Staff and resident's files were reviewed for required information. Based on residents file review and staff interview records for R1 and R2 were not up to date. The deficiency issued on attached LIC 809-D Exit interview conducted, report signed and copy of this report with appeal rights provided to the facility administrator.the state’s words, verbatim · CDSS document, Mar 5, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Mar 7, 2025

87506 Resident Records. (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not observe das evidenced by: The facility administrator failed to follow title 22 regulation by maintaining current resident files, which poses potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 5, 2025

Plan of correction: The administrator will update and provide current resident records proof to LPA by email by POC due date.

Type of visit: Required - 1 Year

On 09/04/2024, Licensing Program Analyst (LPA) V Gorban arrived unannounced to conduct a Required Annual Inspection. LPA met with Manager Ananh Vatah and announced the purpose of the inspection. Administrator Jasmin Burns was notified of Licensing visit and was able to attend it, certificate number 6050729704 with current expiration date 2/3/2025. During the inspection, LPA toured the facility inside and outside. Exits and passageways were clear and free from obstruction. Smoke detectors, carbon monoxide detectors, and fire extinguisher were present and operational. LPA reviewed facility Emergency and Disaster Plan. Common areas were clean, odor free, adequately lit, and provided comfortable seating for all residents. The facility was at a comfortable temperature and the thermostat read 74 degrees Fahrenheit. Chemicals, detergents, and cleaning supplies were secured in locked cabinets. The facility had an adequate supply of clean linens and blankets. LPA observed a sufficient supply of personal protective equipment and reviewed facility infection control practices to meet requirements. LPA observed a sufficient supply of perishable and nonperishable foodstuffs. Refrigerator and freezer were clean and food items were stored and marked properly. Fire extinguisher with service date 05/14/2024. Smoke and carbon monoxide detectors were tested and found operational. LPA toured resident bedrooms and bathrooms. Bedrooms and bathrooms were clean, odor free, and had required minimum furnishings. There was one resident receiving hospice care services at the time of inspection. Bathrooms had required secure grab bars and non-skid mats, and water temperature 104 was within acceptable temperature range. Resident medications were secured in a locked cabinet in the kitchen area. LPA reviewed three residents' medications and medications and medication administration records, and medications appeared to be administered properly. LPA reviewed a sample of staff files and all resident files: required records were present in resident and staff files. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted.the state’s words, verbatim · CDSS document, Sep 4, 2024

Type of visit: Required - 1 Year

On 10/11/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Required Annual Inspection. LPA met with Manager Jasmin Burns and announced the purpose of the inspection. Administrator certificate is current with expiration date 2/3/2025. During the inspection, LPA toured the facility inside and outside. Exits and passageways were clear and free from obstruction. Smoke detectors, carbon monoxide detectors, and fire extinguisher were present and operational. LPA reviewed facility Emergency and Disaster Plan. Common areas were clean, odor free, adequately lit, and provided comfortable seating for all residents. The facility was at a comfortable temperature and the thermostat read 76 degrees Fahrenheit. Chemicals, detergents, and cleaning supplies were secured in locked cabinets. The facility had an adequate supply of clean linens and blankets. LPA observed a sufficient supply of personal protective equipment and reviewed facility infection control practices to meet requirements. LPA observed a sufficient supply of perishable and nonperishable foodstuffs. Refrigerator and freezer were clean and food items were stored and marked properly. LPA toured resident bedrooms and bathrooms. Bedrooms and bathrooms were clean, odor free, and had required minimum furnishings. There were three residents receiving hospice care services at the time of inspection. Bathrooms had required secure grab bars and non-skid mats, and water temperature was within acceptable temperature range. Resident medications were secured in a locked cabinet in the kitchen area. LPA reviewed three residents' medications and medications and medication administration records, and medications appeared to be administered properly. LPA reviewed a sample of staff files and all resident files: required records were present in resident and staff files. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted.the state’s words, verbatim · CDSS document, Oct 11, 2023