Saint Jeanne Care Home

Type of visit: Case Management - Other

At approximately 8:30 AM, Licensing Program Analyst (LPA) Robert Frank arrived at the home for the purpose of conducting a closure inspection pursuant to voluntary closure of this licensed Residential Care Facility for the Elderly. LPA met with Administrator Denice Tambauan who submitted the written notice letter of facility closure to the Santa Rosa Regional Office via e-mail on 05/16/2025. The letter indicates the facility is closing due to difficulties and prolonged non-admission of residents. LPA inspected all rooms and the exterior of the building today and found no evidence that would suggest that any residents are residing on the premises. The Administrator initiated this facility closure and did not submit a closure plan as there have never been any residents admitted to the facility since the license was granted. Closure of this facility has been finalized. Facility was closed effective 05/30/2025. Licensee turned over copy of License during today's inspection. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Administrator Tambauan. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 30, 2025

Type of visit: Post Licensing

At approximately 12:50 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required Post Licensing Visit and was greeted by Administrator Denice Bunag-Tambauan. Saint Jeanne Care Home, LLC is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single Story ranch house. The facility has an approved fire clearance for five (5) non-ambulatory residents. The facility has a Hospice Waiver for three (3) residents. Upon arrival, LPA was informed that there were zero (0) residents in care. At approximately 1:05 PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 1:15 PM, LPA toured the facility with Administrator Denice Bunag-Tambauan. All exits were clear and unobstructed. The facility's fire extinguishers were last serviced and tagged on 5/23/2024. Food supply was sufficient. The facility was sufficiently lighted. LPA inspected two (2) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to future residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 LPA reviewed two (2) staff files. All staff files were found to be well organized with all required documentation including First Aid and CPR certification and proper training documentation. LPA observed a locked cabinet, individual bins and central storage logs for future resident's medications. The facility will not handle future resident’s monies for personal and incidental items. During Today's Inspection LPA reviewed the following items with Administrator Bunag-Tambauan: Initial staff training; Annual Staff Training; Staff and Resident file requirements; the importance of documentation and the Community Care Licensing Inspection process. Denice Bunag-Tambauan Administrator Certification 5057657740 is current with an expiration date of 7/29/2026. LPA requested the following documents be submitted to Community Care Licensing by 5/18/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility (Once staff is hired) LIC 610E Emergency Disaster Plan Proof of Liability Insurance No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Administrator Bunag-Tambauan. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 18, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Alviso conducted a pre-licensing inspection, at approximately 9:20am on 9/13/24, and met with Applicant Denice Tambauan. Catherine Tambauan-Hagan was also in attendance, and is planning to be the facility Administrator. LPA conducted a component III orientation with Applicant Denice Tambauan and Catherine Tambauan-Hagan, on 9/13/24. Applicant has an approved fire clearance for five (5) ambulatory residents- effective 6/6/24. There is a carbon monoxide detector in the facility, which is also a smoke alarm. All required rooms have a smoke alarm. There are three (3) resident rooms, two (2) are shared rooms (2 to a room), and one (1) is a private room (for 1 only). Per fire clearance approval of ambulatory residents only, the hospice waiver request for three (3) can't be approved. Residents on hospice must be residing in a non-ambulatory fire cleared room. Applicant states that she wants to request another fire clearance inspection to be completed as they are questioning the approval; The facility has required ramps, one in the front of the home, and the other in the backyard, which leads to a gate out to the front of the home. Applicant stated that fire inspector stated to them, every room had to have a direct exit to the outside, but applicant stated they believe this was a mistake, other facilities have non-ambulatory and don't have direct exit out. LPA stated to the applicant, they may resubmit the facility sketches, include all outside buildings that were not part of the fire clearance inspection, though they are on the sketch. LPA will send out a fire clearance request with sketches, and explain capacity requested, to the local fire department for re-inspection. Applicant agreed to submit required documents for the fire clearance reinspection. Applicant has submitted a required emergency disaster plan, and a required infection control plan. The LPA toured the facility with applicant and hired Administrator. All bathrooms were clean, had grab bars, and non-slip flooring and/or mats in showers for resident use. Hot water was checked at 105.2 degrees Fahrenheit. Continued on LIC809C... All resident rooms, common areas, and outside spaces were found to be clean and orderly. Facility had sufficient lighting in resident rooms, bathrooms, and common areas. Medications will be locked up in cabinets set up for centrally storing medications. All disinfectants/cleaners were locked up and inaccessible. All exits were free and clear from obstruction, including the two ramps. Fire extinguishers were serviced and tagged as required-four (4) dated 5/23/24. Sufficient supply of linens, dishes, and furnishings for resident use. Applicant is obtaining the required 72-hour shelter in place supplies for the facility.The backyard and deck were observed to be clean and orderly; The applicant is obtaining patio furniture, including shade umbrellas, for residents to use. All outside walkways/pathways were free and clear of obstruction as required. The applicant will be ensuring a sturdy gate is added off the backyard deck/ramp, where there are three steps down onto the cement yard, to help ensure health & safety of residents in care. The facility's outside buildings, consisting of a large activity room, a staff sleeping room, an office room, small storage room, and large storage room; These outside facility buildings will be inspected in the fire clearance request the LPA will send out once required documents are received from the applicant. Once the fire clearance is obtained, the LPA will contact the applicant to discuss the new fire clearance approval. LPA will notify the application unit when all discussed items are obtained, and completed, including new fire clearance.the state’s words, verbatim · CDSS document, Sep 13, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 5 Census (if any clients in care): 0 COMP II Participants: Name - John & Denice Tambauan CEO/ Catherine Tambauan-Hagan Administrator Interview Method: Telephone interview On August 22, 2024, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Aug 22, 2024