J and V Family Care Home

On 04/22/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection. LPA met with administrator Julita Andaya and explained the purpose of today's visit. Currently there are 6 residents in place and 2 staff at time of visit. The administrator arrived later during today's visit and met with LPA. The facility is licensed for age range 60 and over. All may be non-ambulatory. Facility has a waiver for 3 residents. Hospice resident is allowed in bedroom #2 only. There currently are 2 hospice resident in care. This is a single level facility. Facility temperature is comfortable for residents in care. Facility emergency food supplies such as canned goods are in place. Additional supplies are in the garage as well. There are 4 resident rooms. Water temperature is tested in both facility bathrooms. The water temperature is measured at 120F in the bathroom adjacent to room 1 and 130F in the other bathroom located near room 4. Cleaning supplies in the kitchen are observed as locked beneath the kitchen sink. Additional cleaning supplies are locked in the garage in a storage cabinet. Facility knives are observed to be locked in a drawer beneath below the kitchen sink. Kitchen food supplies are observed to be in place with 2 day fresh food supply and canned goods fulfilling the 7 day emergency food supply. A tour of the outside of the facility is conducted. Emergency routes are free and clear of any obstructions. No locks are observed on both gates. Smoke detectors and carbon monoxide detectors are located through out the facility. LPA observed 2 fire extinguishers in the facility. Both are observed as charged and ready for use. Facility does not have disaster drill records on file to review. Linens are in place for resident use stored in a hallway closet and in resident room closets. Continued on next page... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 2 LPA observed all resident rooms and observed that they contain the required furniture and lighting as outlined in Title 22. Medications, first aid kit, are stored in a locked medication cabinet in the kitchen. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hygiene supplies are in place. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed as current. LPA reviewed staff and resident files on this day. Resident # 5 and #6 physician's report is observed to be out of date with no current assessments or updates on file. Both residents have dementia diagnosis. Staff training records are observed to be current and in place. Administrator certificate for Julita Andaya is observed as expired as of 01/23/2025 but has submitted renewal items and new certification is processing. Report is reviewed with Julita Andaya. A copy of this report is provided to the facility. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Advisory Notes--7 pages--for technical violations to be addressed.

LPA Audrey Jeung toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. Hot water temperature is tested. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 5 residents present, and 2 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. Julita Andaya is a certified RCFE administrator (x 2/25) that oversees facility operations. Client files are reviewed, including medications, which are recorded on Centrally Stored Medications Records. The following forms are requested to be updated and returned to CCL by 4/29/24: • LIC 308 Designation of Administrative Responsibility • LIC 309 Administrative Organization • LIC 500 Personnel Report • LIC 610D Emergency Disaster Plan • Proof of current liability insurance - Infection Control Plan Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Advisory Notes--7 pages--for technical violations to be addressed.