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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601126
Report Date: 09/08/2023
Date Signed: 09/08/2023 03:15:26 PM

Document Has Been Signed on 09/08/2023 03:15 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BMJ RESIDENTIAL CARE HOMEFACILITY NUMBER:
374601126
ADMINISTRATOR:MARILYN B. JIMENEZFACILITY TYPE:
735
ADDRESS:1006 CHESTNUT DRIVETELEPHONE:
(760) 690-2443
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 5DATE:
09/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Melissa Sumibcay, AdministratorTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility for the purpose of an annual inspection. LPA was greeted by Lead Staff, Rosa Flores and explained the purpose of the visit. A tour of the facility was conducted inside and out. At the time of visit, there were five (5) clients home and four (4) staff present. Administrator Melissa Sumibcay arrived shortly.

The facility is a six (6) bedroom two (2) bathroom one story home. Three (3) bedrooms are shared, two (2) clients to a bedroom, and three (3) bedrooms are reserved for live-in staff. Staff and client interviews were conducted.

During the tour the following was observed: Clients bedrooms had the required furnishings and were observed to be in good condition. Bathrooms had required signage, hand rails, non-slip mats. Night-light was observed in the hallway. Fixtures and furniture for an operational facility are present and in good repair. All passageways were free of obstructions, charged fire extinguisher and the fire alarm system was operable, medications are kept centralized and locked, hazardous items are kept inaccessible to clients. Hot water was tested at 118 degrees Fahrenheit. Backyard area is free from obstructions.

Kitchen/Food Service: LPA observed the entire kitchen, food is stored properly and dishes are clean and in good condition. There is a sufficient supply of perishable and non-perishable foods. Area was observed to be clean and functional.

Care & Supervision: Facility has sufficient care staff employed.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BMJ RESIDENTIAL CARE HOME
FACILITY NUMBER: 374601126
VISIT DATE: 09/08/2023
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Administration: Emergency exiting plans, telephone numbers and Ombudsman information and other required signage are posted throughout the facility. Drills are conducted monthly. The last drill was 08/15/23. Licensee fees are up to date.

Record Review and Client/Staff Files: LPA reviewed current staff records and all staff have Criminal Background Clearance, current CPR/First Aid certification, and trainings are current. Client records were reviewed and contained required documents. IPP and Physician reports are current. LPA reviewed P&I logs, records are balanced. P&I funds are kept separately from facility funds.

Medication Review: LPA reviewed medication and medication log. Residents' medications are being dispensed according to physician's orders.

No deficiencies were cited per Title 22, Division 6 of the California Code of Regulations at this time.

An exit interview conducted and a copy of this report was provided to Administrator, Melissa Sumibcay
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC809 (FAS) - (06/04)
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