Tennessee Care

Type of visit: Required - 1 Year

At approximately 1:15 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Administrator Mark Sy arrived at 1:35 PM. Tennessee Care 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 four (4) non-ambulatory residents. The facility has a Hospice Waiver for two (2) residents. Upon arrival, LPA was informed that there were four (4) residents in care and two (2) staff members on-site. At approximately 1:25 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 1:30 PM, LPA toured the facility. All exits were clear and unobstructed. The facility's one (1) fire extinguisher was last serviced and tagged on 7/8/2025. The extinguisher was observed to be charged and operational. The facility was sufficiently lighted. LPA inspected four (4) 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 residents. The 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 observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 2:05 PM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed to be well organized and thorough with all required documentation. LPA reviewed four (4) staff files. Four (4) of four (4) staff files were observed to be well organized with all required documentation including First Aid and CPR certification and proper training documentation. LPA audited Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. Client’s monies for personal and incidental items (P&I) were audited and observed to balance to P&I logs. Mark Sy’s Administrator Certification 6074468740 is current with an expiration date of 12/15/2026. LPA requested the following documents be submitted to Community Care Licensing by 9/18/2026: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance The facility is in compliance. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to back up Administrator Rachel Sy. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 18, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Hansen arrived at Tennessee Care, LLC unannounced for the purpose of conducting a Required-1 year inspection. LPA met with Jayson Sy, Licensee/Administrator. This single story 4 bedroom facility is licensed for 4 non-ambulatory residents, with a Hospice Waiver for 2. LPA toured the building and grounds and found the home to be clean, organized, at a comfortable temperature with all exits free from obstruction. There are also, 2 bathrooms, living room, dining room, kitchen and garage. There was a 2 day supply of perishable and 7 day supply of non-perishable foods as per Title 22 regulations. Food stored in the kitchen refrigerator was properly stored as per regulations on this day at the time of the visit. Water temperature in the resident bathroom was found to be within appropriate range of 105-120 degrees F. Bathrooms were equipped with necessary grab bars, and slip-resistant mats, strips, or flooring in all bathtub and shower floors as required by Title 22 regulations. Cleaning products and knives are stored in key locked cabinets in the kitchen and locked cabinets in the garage. All bedrooms have lighting & appropriate furnishings per Title 22 regulations. Fire place, wood stove is observed with a screen/gate and licensee explained that it is not used. A review of four resident & four staff records as well as two resident medications was conducted. LPA reviewed resident’s files at 8:45 AM on 8/14/2025 and learned that 4 of 4 residents have an updated reappraisal/needs & care plan, TB and physician’s assessments on file as required by Title 22 Regulation. Medications were centrally stored in locked closet in living room, overflow of medication in office cabinet. Continue on LIC809-C Continued from LIC809 At approximately 10:45am a sample review of Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. LPA reviewed a sample of staff records at 9:30 AM on 8/14/2025 and learned that all facility staff present and other individuals who require caregiver background checks have received criminal record clearances or exemptions. In addition, Direct care staff at the facility have received additional training requirements. LPA was presented with proof of CPR & 1st Aid certification for staff that files were reviewed. 1 (new staff) out of 4 staff files reviewed did not have health screening or TB test results (see LIC809D) Smoke detectors and carbon monoxide detectors were tested and operational. Fire extinguisher was observed charged & serviced July 8, 2025. Disaster drills are conducted quarterly with the last documented on 5/9/2025. Facility has a generator in case of power outage. Administrators certificate for Jayson Sy #6074468740 expires 12/15/2026. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 7/31/2025: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Aug 14, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Araceli Canela arrived at Tennessee Care, LLC unannounced for the purpose of conducting a Required-1 year inspection. LPA met with Jayson Sy, Licensee/Administrator. This facility is licensed for 4 non-ambulatory residents, no approval for bed ridden and a Hospice Waiver for 2 of the residents. LPA toured the home and found the home to be clean, organized, at a comfortable temperature with all exits free from obstruction. There are a total of four bedrooms, 2 bathrooms, living room, dining room, kitchen and garage. Smoke detectors and carbon monoxide detectors were tested and operational. The fire extinguisher was observed charged & serviced July 10, 2024. Fire drill was conducted & documented on 5/26/2024. Water temperature in the resident bathroom was found to be within appropriate range of 105-120 degrees. Bathrooms have required non-skid surfaces and grab bars. Cleaning products and knives are stored in key locked cabinets in the kitchen. Fire place, wood stove is observed with a screen/gate and licensee explained that it is not used. There was a 7 day supply of non-perishable foods. There are adequate dishes, glasses and silverware. LPA reviewed staff files and staff have the required training and proof of CPR/1st aid that expires 1/20/2025 & 4/28/2025. Resident files were found complete and organized. Administrators certificate for Jayson Sy #6042012740 expires 9/19/2024 and licensee submitted renewal paperwork. Licensee/Administrator to submit the following documents for our file by 10/15/2024:· LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents Infection Control Plan of Operation (If changes) & Copy of Liability Insurance No citations issued during todays inspection.the state’s words, verbatim · CDSS document, Sep 13, 2024