JASMINE'S HOME CARE

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, faucets in bathroom#1 and #2 measued to read 144.5 F degrees when tested by LPA, the licensee did not comply with the section cited above in 5 out of 5 residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Administrator lowered the water heater during LPA's visit, this cleared 24hr correction. Administrator agreed to create a water temp log and record water temperatures in all areas of grooming for the next 7 calendar days, starting 04/17/2026. Administrator agreed to send LPA a copy of recorded water temps from 04/17/2026 through 04/23/2026. Proof must be submitted by 04/24/2026.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, LPA observed an accessible 2liter bottle of liquid drain opener (drain-o), the licensee did not comply with the section cited above in 5 out of 5 residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/16/2026 Plan of Correction Staff immediatley removed the liquid sink drainer and placed them in a location inaccessible to residents. This clears 24hr correction.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, unlocked kitchen cabinets that contained prescribed medication, over-the-counter pain relivers & liquid cough syrup, and various supplements, the licensee did not comply with the section cited above in 5 out of 5 residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/16/2026 Plan of Correction Staff immediately locked medications cabinets while LPA was present. Staff moved the OTC medications and supplements into another locked cabinet. This clears 24hr correction.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, Administrator could not provide proof of liability insurance, the licensee did not comply with the section cited above in 5 out of 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Administrator agreed to send proof of current liability insurance according to above regulation. Proof must be received via email no later than 04/24/2026.

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, poster was not 20 " x 26 " as required and was not posted in the main entryway of the facility the licensee did not comply with the section cited above in 5 out of 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Administrator agreed to post poster according to above regulationa and send LPA picture proof of poster and its location. Photo must be submitted via email no later than 04/24/2026

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, S1 & S2 did not have proof of staff training (initial & annual) & orientation verification in their personnel records, the licensee did not comply with the section cited above in 2 out of 2 staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Administrator agreed to send LPA copies of S1 & S2's staff training & orientation verification, via email.

Official classification

Type B

Official code

87465(a)(8)

Regulation authority

CCR

What the official deficiency says

(8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, kit was missing scissors, tweezers, thermometer or first aid manual in first aid kit. the licensee did not comply with the section cited above in 5 out of 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Administrator agreed to send receipt of above missing items or new first aid kit, via email.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, observed R7's medical assessment was incomplete and not endorsed by the physician that conducted's R7's assessment, the licensee did not comply with the section cited above in 1 out of 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Administrator agreed to get R7's medical assessment endorsed. Proof must be submitted via email.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, observe a signed original admission agreement for R7 the licensee did not comply with the section cited above in 1 out of 5 resident which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Administrator agreed to send proof of R7's signed admission agreement, via email.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation & record review, R4's bed had full bed rails and was not on hospice care, the licensee did not comply with the section cited above in 1 out of 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/16/2026 Plan of Correction Administrator removed full bed rail during LPA's visit. POC cleared during visit.

Official classification

Type B

Official code

87633(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record: (5) A statement signed by the resident's roommate, if any, or any resident who will share a room with a person who is terminally ill to be accepted or retained as a resident, indicating his or her acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident's life, and the roommate's voluntary agreement to grant access to the shared living space to hospice caregivers, and the resident's support network of family members, friends, clergy, and others. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, R7 did not have a signed statement indicating their acknowledgment that R6 intends to receive hospice care, the licensee did not comply with the section cited above in 1 out of 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2026 Plan of Correction Administrator agreed to send proof of signed statement by R7, via email.

Official classification

Type A

Official code

87355(e)(2)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:(2)Obtain a California clearance or a criminal record exemption as required by the Department or (3)Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by: S3's personnel record did not have proof of criminal clearance or proof of request of transfer of criminal record clearance.

Official plan of correction

Administrator Maghirang will submit a plan on when S3's criminal clearance or transfer of criminal record clearance. Plan must be received by 03/13/2026. Administrator Maghirang agreed that S3 will return to the facility once S3's criminal clearance is received in their file.

Deadline recorded: Mar 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: LPA observed water temperature measured at 134.4 degrees Fahrenheit in bathroom #1 and 137.1 degrees Fahrenheit in bathroom #2. Deficient Practice Statement Based on observation, the administrator did not comply with the section cited above in 2 out of 2 bathrooms, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/18/2022 Plan of Correction Administrator will ensure that water temperature measures between 105 degrees and 120 degrees Fahrenheit as required. Administrator will send LPA a log with water temperature readinsg for 3 days by POC due date.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: LPA observed that Resident #1's Senna 8.6 mg medication dated 4/20/22 has not been administered. The medication states that is is to be given daily. Deficient Practice Statement Based on observation, the administrator did not comply with section cited above which poses an immediate health and safety risk to personsl in care.

Official plan of correction

POC Due Date: 05/18/2022 Plan of Correction Administrator will ensure that all medication is administered as required. Administrator will provide proof of medication training to Staff by POC due date.