Willie Mae Hands

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced annual inspection visit at the facility using the CARE inspection tool. LPA met with Administrator Jennifer Stinson and explained the reason of the visit. The facility serves the age range of 60 and over residents. The fire clearance has been approved for six (6) ambulatory residents, four (4) of which may be bedridden. Room #1 and #5 have two bedridden approved beds and a waiver/granted for hospice care for four (4) residents. This property is currently licensed since 01/22/2025. The physical plant was toured with the Administrator Jennifer Stinson approximately at 9:00am. The facility is a one-story family home in a residential area. There are three (3) shared resident bedrooms, two (2) staff office/staff room/storage, three (3) bathrooms, living room/dining room, kitchen, front yard, back yard with shaded seating area, and a detached garage. The home does not have a pool or any large bodies of water. LPA conducted the tour and observed the following: Smoke and carbon monoxide detectors were observed throughout the facility. Resident's bedrooms were observed to have required furniture such as bed frames, dressers, chairs, lamps, and sufficient drawer space and the required bedding was also observed. The home has three (3) bathrooms that were clean and sanitary. The water temperature was tested and measured at 110.0-116.3 degrees Fahrenheit, which is within the required 105-120 degrees Fahrenheit. There were two (2) fully charged fire extinguishers observed in the kitchen and laundry area. All appliances in the kitchen were observed to be operational. *****Continue LIC 809C***** The sharp knives are located in a kitchen cabinet locked and inaccessible to residents. Cleaning supplies and chemicals are stored in a locked cabinet in the the kitchen. No medications are being centrally stored due to the facility not having residents housed at this time. No files have yet been created due to no residents being housed. All files will be kept in the office in the future once residents are housed. The garage will be utilized for additional storage and cleaning supplies . No records have been reviewed due to the home not having residents since being licensed 01/22/2025. Per California Code of Regulations, Title 22, the facility meets the physical plant requirements. Exit interview held with Jennifer Stinson and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 2, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christian Gutierrez conducted a pre-licensing visit. LPA met with applicant Jennifer Stinson. An initial application was submitted to Community Care Licensing Department (CCLD) for a Residential Care Facility Elderly (RCFE) to serve 6 ambulatory residents. Of which four (4) may be bedridden in room #1 and #5. Waiver granted for hospice care for four (4) residents This property has never been licensed. The physical plant was toured with the applicant. The facility is in a residential area and is a one-story family home. There are three (3) shared resident bedrooms, one (1) storage room, one (1) office, three (3) bathrooms, living room, dining room, kitchen, laundry area, front yard, and back yard. LPA conducted the tour and observed the following: Smoke detectors/carbon monoxide detectors were observed in common areas and in each resident’s bedroom. Residents’ bedrooms were observed to have required furniture such as bed frames, dressers, chairs, lamps, and sufficient closet space. The required bedding was also observed. The home has three (3) bathrooms and are clean and sanitary they all have required grab bars and nonskid mats. The water temperate was tested and measured within the required 105-120 degrees. There is a fire extinguisher in hallway and kitchen. All appliances in kitchen were observed to be clean and operational. The sharp knives are located in the kitchen cabinet that is inaccessible to residents. Cleaning supplies and chemicals are stored in a locked cabinet in kitchen. Medications are locked in a kitchen cabinet. All files will be kept in kitchen. The garage will be used as storage area for residents. The backyard has a shaded area with patio furniture. The home does not have a pool or any large bodies of water. No records were reviewed since the home has never been licensed. Per California Code of Regulations, Title 22, the facility meets the physical plant requirements. Exit interview held and a copy of the report was provided to applicant.the state’s words, verbatim · CDSS document, Dec 12, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Stinson, Jennifer On 11/12/24, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of 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, Nov 12, 2024