Facility Evaluation Report

Licensing Program Analysts (LPAs) Manuel Monter, Kenneth Madrigal & Licensing Program Manager (LPM) Romeo Manzano conducted an unannounced Case Management- Legal/Non-compliance(NCC). LPAs met with Administrator (ADM) Bernelette Taa and stated the purpose of the visit.

The purpose of this inspection was to ensure that the facility is in compliance with Title 22 Regulations and the compliance plan stated on LIC9111 NCC on 7/262024. LPA conducted a random review of 4 resident (R1 to R4) and 2 (S1 to S2) staff files, and toured the facility inside and out.

During visit, LPA observed the staff room directly across to the dining area has been converted into two bedrooms/partition [1 for a resident and 1 for a staff (S1)]. On 11/18/2024, LPA observed 1 of the converted bedroom was occupied 1 male resident (R1) wherein a citation was not issued at the time of visit due to time constraint but discussed it with Administrator/licensee.

Based on a review of STD850 issued on 1/30/2020 by the SJ Fire clearance and facility floor plan approved for 5 bedrooms including staff designated bedroom. ADM stated she did not obtain building permit prior to the building alterations. ADM stated R1 just no longer resides in the staff bedroom, as of January 26, 2025. In addition, while touring bedroom #3 and master bedroom , LPA observed a partition wall inside bedroom#3 and a little office (Photographs were taken) with no building permit including converting master bedroom into bedroom and a main master bedroom door was removed to expand as a hallway. These building alterations are not reflected on the submitted and approved fire clearance and physical plant in 2020. Further review of the STD850, the facility does not have a 'delayed egress,' a secure perimeter or is a locked perimeter with an exception of the swimming pool inaccessible to residents with 5 foot fence and is padlocked. CCLD will clarify and resubmit facility fire clearance to SJFD.