Southern Comfort Care Home 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Licensee Joanne Rimorin and Administrator Shanda Rimorin and introduced self and stated purpose of the visit. LPA was informed that there are currently 5 residents in care who are in the facility. The facility has 4 resident bedrooms, 1 resident bathroom, 2 staff bedrooms with 1 bathroom, kitchen, dining area, living room, laundry room, attached garage, and backyard. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathroom; bathroom was clean and appliances were found functional. Water temperatures tested at 109 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, fire extinguisher and first aid kit. Posters such as; the personal rights, ombudsman, CCL complaint poster and emergency disaster plans were posted in a common area. LPA also observed cleaning supplies, toxins, sharps, and other dangerous items locked in cabinets made inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed secured and inaccessible to residents. There are no guns or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a wide variety of food available for residents. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, a side gate with self-latching handle on the right side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed personnel and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff. LPA reviewed the facility's insurance coverage, emergency disaster plan, infection control plan and emergency drills. No deficiencies were cited during this visit. An exit interview was conducted where this report LIC809, and LIC809C were discussed and copies were provided to the Licensee, Joanne Rimorin and Administrator, Shanda Rimorin.the state’s words, verbatim · CDSS document, Oct 25, 2025

Type of visit: Prelicensing

On 10/03/24 at 9:10AM, Licensing Program Analysts (LPA's) Renese Howell-Small and Melody Brown conducted an announced visit to the facility for the purpose of a Prelicensing Visit. LPA's met with Applicant Joanne Casten and Administrator Shanda Mae Rimorin. An initial application for license to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 06/15/24 for a total capacity of six (6). Fire clearance was granted on 06/05/24 for five (5) non-ambulatory residents and one (1) bedridden. LPA's Howell-Small and Brown observed the following: Structure: Facility was a single story house with six (6) bedrooms; six (6) bedrooms for residents and no staff bedrooms, three (3) resident/staff bathrooms, living room, dining area and kitchen. There is an attached two (2) car garage. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control the entire house. LPA's Howell-Small and Brown observed the temperature to be 72 degrees Fahrenheit. Bedrooms: Each resident bedroom accommodates any non-ambulatory resident. Room "F" is the only approved room for bedridden. All resident bedrooms were adequately furnished with bed, closet, appropriate linen and an operable combined carbon monoxide/smoke alarm. Technical Assistance given for mattress pads, lamps, dressers and chairs for the bedrooms. Bathrooms: The three (3) staff/resident bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. LPA's tested the water temperature in the resident bathrooms. LPA's verified water temperature was measured at 110 degrees Fahrenheit. Continued on LIC809C ***CONTINUED FROM LIC809*** Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked cabinet located in the hallway. There was adequate room for food storage. LPAs observed the stove to be operational. Refrigerator/freezer were in working condition. There is more than seven (7) days’ supply of non-perishable foods and more than two (2) days’ supply of non-perishable foods. There’s an adequate seating for meals for all residents. Laundry room with washer and dryer. Laundry detergents and cleaning supplies are stored in the chemical storage room. Technical Assistance given to provide trash bins with tight fitting lids. Living/Family room: There’s a living/family room with adequate seating for all residents and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. Gates on the right side of the facility. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted in the hallway. Ombudsman poster, Let-Us-No poster, Personal Rights, Emergency Disaster Plan were observed. Dementia Care Plan: LPAs Renese Howell-Small and Melody Brown observed and reviewed the Dementia Care Plan during the visit. General items: two (2) fire extinguisher(s) were charged and located throughout the facility. Dual smoke alarms and carbon monoxide detectors were tested and were observed to be in working order. Resident records will be stored in a locked cabinet in the office room. First Aid kit with required components, First Aid book and locked area for medication storage was observed. LPA's observed a facility phone and was operational as evidenced of LPA dialing the number. ***CONTINUED ON LIC 809C*** ***CONTINUED FROM LIC 809C** The phone number designated for the facility is (951) 599-0172. The required 72-hour emergency food supply was observed. Technical Assistance given to obtain additional water and emergency supplies. Component III was completed on this day as well. LPAs observed activities for the residents such as books, games and magazines. Additionally, upon entry, LPAs observed the facility having Visitor Sign In/Sign Out Sheet and Resident Sign In/Sign Out Sheet. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report was reviewed and provided to Applicant Joanne Casten.the state’s words, verbatim · CDSS document, Oct 3, 2024

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): COMP II Participants: Shanda Mae Rimorin, Joanne Casten Rimorin Interview Method: Telephone interview On August 28, 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 following areas: 1. Facility operation: License type, client/resident populations, and program 2. Medications/Unusual Incidents 3. Staffing requirements & Training 4. Pre-Licensing inspection readinessthe state’s words, verbatim · CDSS document, Aug 28, 2024