336402166-2-21-2025-18-AS-JGEE-DE4TAS-20250221133400

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336402166
Report Date: 02/21/2025
Date Signed: 02/21/2025 01:34:07 PM

Document Has Been Signed on 02/21/2025 01:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	JMP CARE HOME		FACILITY NUMBER:	336402166
ADMINISTRATOR/ DIRECTOR:	EMELITA M. PRICE		FACILITY TYPE:	740
ADDRESS:	2771 CAMBRIDGE AVENUE		TELEPHONE:	(951) 282-2819
CITY:	HEMET	STATE: CA	ZIP CODE:	92545
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	02/21/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:35 AM
MET WITH:	Alan Price, Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

NARRATIVE
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	On 02/21/25 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA was greeted and granted entry by caregiver Rositas Melendro. Below are the observations made from today's visit: The facility currently has (1) resident in care that was at program during LPAs visit. There was (1) staff present. The facility is a single story structure consisting of (4) bedrooms and (2) bathrooms. The facility is utilizing video surveillance in the common areas. The following is needed an updated facility sketch, an addendum to the plan of operation, as well as a consent from the resident acknowledging that they agree and were informed that video surveillance will be utilized in the facility. LPA observed for there to be a locked storage food room inside the garage that staff did not have access to, it is not included on the facility sketch. LPA observed for there to be a live cockroach crawling around the kitchen floor, as well as a baby cockroach on kitchen counter. Per Mr. Price the facility is doing their own extermination treatment. In addition LPA observed for there several expired food items of canned peas (4), cranberry sauce(3), refried beans (4), and (6) boxes of cake mix dating back to March 2018. LPA observed for there to be crumbs throughout the refrigerator in addition to resident medication that requires refrigeration. Deficiency cited. The Administrator Mr. Alan Price agreed to bring the small refrigerator to the facility today, Proof is to be submitted to department by 5pm 02/21/25. All staff present were observed to have criminal record clearance and were associated to the facility. The smoke and carbon monoxide detectors were tested and observed to be operable. The water temperature was tested and was found to be within regulatory limits measuring at 106.8 degrees Fahrenheit. The medications (bubble packs) were observed to be locked and inaccessible to residents in care. Based on today's inspection deficiencies were be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report, 809D, appeal rights, LIC808-Proof of corrections form and LIC811-confidential names list was provided to Administrator Alan Price.

Tricia Danielson	TELEPHONE: (951) 202-5067
Javina George	TELEPHONE: (951) 217-3970
	DATE: 02/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/21/2025 01:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: JMP CARE HOME	FACILITY NUMBER: 336402166
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

HSC

1569.695(c)

Other Provisions

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 times which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/22/2025
	Plan of Correction
1 2 3 4	The licensee agrees to conduct a drill, document it. Proof of POC is to be submitted to the department by 5pm on the due date indicated.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Tricia Danielson	TELEPHONE: (951) 202-5067
Javina George	TELEPHONE: (951) 217-3970
	DATE: 02/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/21/2025 01:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: JMP CARE HOME	FACILITY NUMBER: 336402166
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87303(a)(1)

Maintenance and Operation

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 1 out 1 times which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	The licensee agrees to conduct an inservice on the importance of maintinaing clean, safe and sanitary conditions. Proof of POC is to be submitted to the department by 5pm on the due date indicated.

Type B

Section Cited

CCR

87555(b)(8)

General Food Service Requirements

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	The licensee agrees to go through the cabinets and discard the expired food items, in addition to going shopping and providing a copy of the receipt for the food purchased. Proof of POC is to be submitted to the department by 5pm on the due date indicated.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Tricia Danielson	TELEPHONE: (951) 202-5067
Javina George	TELEPHONE: (951) 217-3970
	DATE: 02/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/21/2025 01:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: JMP CARE HOME	FACILITY NUMBER: 336402166
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87555(b)(27)

General Food Service Requirements

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interviews, the licensee did not comply with the section cited above in 2 out of 2 times which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2025
	Plan of Correction
1 2 3 4	The licensee agrees to treat the home for the pests. Proof of POC (purchase of products) is to be submitted to the department by 5pm on the due date indicated.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Tricia Danielson	TELEPHONE: (951) 202-5067
Javina George	TELEPHONE: (951) 217-3970
	DATE: 02/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

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