Facility Evaluation Report

On 07/28/2025 at 8:05am, Licensing Program Analyst (LPA) Zina Brown conducted a unannounced case management visit at the facility to address specific health and safety concerns. During today visit we met with Jemimah Mejia, Administrator and explained the purpose of the visit.

During today's visit, LPA interviewed the administrator and staff. LPA also reviewed and collected the following documents:

LIC 500: Personnel Report (dated 05/05/2025)

Roster of Facility Residents/Clients (received 07/28/2025)

LIC 601: Identification and Emergency Information (Client #1 - dated 07/28/2025)

LIC 602: Physician's Report for Community Care Facilities (Client #1-date 10/30/2024)

LIC 604: Admission Agreemnet (Client #1 - dated 09/18/2024)

LIC 613: Personal Rights (Client #1 - dated 09/18/2024)

LIC 625: Appraisal/Needs and Service Plan (Client #1 -dated 09/18/2024

House Rules (Client #1 - dated 09/18/2024)

Medication Administrator Record (Client #1 for July)

Between the hours of 9:34 am-9:45 am, conducted a tour of the facility and also inspected the following 11 rooms: Room 7, 9, 17-23, 30 and 37.

LPA observed the following not in compliance: On 07/24/2024 , LPA interviewed the Administrator who stated the facility did not report to licensing about the bedbugs discovered in clients personal rooms.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8),a deficiency has been observed, and citation issued (ref. LIC 809-D). An exit interview was conducted, and a copy of the Evaluation Report and Appeal Rights were provided to the Administrator (Jemimah Mejia).