045002773-8-4-2021-25-AS-MVAA-C5KQNW-20210804121950

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045002773
Report Date: 08/04/2021
Date Signed: 08/04/2021 12:22:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME:	ROSELEAF OROVILLE		FACILITY NUMBER:	045002773
ADMINISTRATOR:	BROWN, TERRY L		FACILITY TYPE:	740
ADDRESS:	1900 20TH ST		TELEPHONE:	(559) 970-1240
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95965
CAPACITY:	60	CENSUS: 30	DATE:	08/04/2021
TYPE OF VISIT:	Case Management - Health Checks	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Administrator, Terry Brown		TIME COMPLETED:	12:45 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 08/04/2021, Licensing Program Analysts (LPA) Misty Valencia and Dawn Keane, conducted an in-person health and safety check visit due to Covid outbreak and met with Administrator, Terry Brown, Infection Preventions Kristy Trausch, and Butte County Public Health Staff Linda. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 masks, gowns, and gloves. LPA toured the facility inside including but not limited to resident room hallways, facility dining areas and common areas. LPA observed multiple residents in their rooms. Care needs were being met. LPA's observed two staff not wearing N95 masks, Admin handed them an N95 mask and had a discussion regarding that all staff has to wear a N95 mask while covid is in the building. LPA confirmed the following current staff on AM shift one med tech, four caregivers, one housekeeper, the cook as well as the Administrator. The advice topics covered are: · More signage- Infection control, distancing and hand washing at entrances, in break rooms, bathrooms, at sinks, Don and Doff signs at Covid pos rooms- Don outside the room, doff inside In the break room, kitchen and med room- distancing and disinfecting signs. · Develop more strategies to distance, especially memory care residents and attempt to cohort known positives. continued on 809-C

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ROSELEAF OROVILLE	FACILITY NUMBER: 045002773
	VISIT DATE: 08/04/2021

NARRATIVE

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· Continue to try to train, encourage, incentive, remind mask use of residents. Try many colors and styles.
· Have the conversation with both families of the +/- shared rooms to see what is possible to minimize exposure.
· Greater emphasis on staff changing PPE between infected/ non- infected areas.
· Gloves should be changed A LOT.
· Paper towels at all hand washing sites.
· Covid positive rooms closed when possible.

Infection Preventionist Kristy Trausch also concluded a Prevention Infection Control meeting that included the following; recommendations and questions the facility had regarding Covid-19.

Following items were included in the meeting
-Cleaning supplies and making sure they were up to EPA Standards
-Staff back up plan in case of outbreak-bright star-staffing agencies
-Resident checks and to look for any signs/symptoms of Covid
-PPE supplies
-Visitation plans
-Testing for Covid and meeting state surveillance requirements
-Activities and the need for continuing social distancing
-Staff educating regarding covid, PPEs, and social distancing

HAI Trausch asked Admin if she needed assistance with anything. Admin reported “That the only thing really needed are all PPE supplies, masks, gowns, face shields, and sanitizer. Admin was thankful for the support and will reach out if anything is needed.

continued on 809-C

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ROSELEAF OROVILLE	FACILITY NUMBER: 045002773
	VISIT DATE: 08/04/2021

NARRATIVE

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Capacity-60

Census-29

3/29 residents are in the hospital

Positive cases lab confirmed 23/29-1 death on Sunday morning that had no symptoms and was never tested. Resident was independent and was joking Saturday night who had underlying condition including Heart failure.

Positive cases with staff 9/20

Currently staff 4/5 has come back. 2 hospitalized--1 has been discharged 1 still in hospital.

Vaccination- 3/29 residents not vaccinated. 3/20 staff are vaccinated.

Every Monday everyone who is not positive is getting tested.

Supplies-needed LPA will provide Surgical masks-N95 masks, hand sanitizer, face shields, donning and doffing videos.

Mask fit testing today 08/04/2021 or complete a self check-videos will be sent over for those who were not available.

Eye protection-make sure using and protecting the eyes

-double bed rooms-shared jack and Jill bathrooms (up to 4 people may share a bathroom)- 1 in a private room, but the ones that are double beds the other bed is unoccupied. Keep positive/negatives separated. Give positive a commode so they don’t share a bathroom. Census is low will move negative from the positive.

Will start independent testing for those who are able to test

Breaks-1 person only per break room. Staff does not go on break together.

continued on 809-C

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ROSELEAF OROVILLE	FACILITY NUMBER: 045002773
	VISIT DATE: 08/04/2021

NARRATIVE

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Masks-residents will not wear the masks they take them off and it creates behavior. Please encourage them to wear masks especially while being provided care.

No communally dining currently.

No visiting except hospice visitors-3 on hospice.

Vitals-every 4 hours for the positives? Any kind of change we contact EMS.

Hospice comes in make sure they are masked and wearing PPE.

Cleaning and disinfecting-cleaning with products the kill covid. Supplies come from Eco lab. Constant throughout the day.

Offer vaccination-encourage with in service-training

PPE training if needed

Activities staff-she’s been out haven’t been doing activities, residents are bored. Residents are doing activities in their rooms on their own.

All staff and visitors are screened upon entrance and leaving the facility.

Admin reported that she will contact LPAs if anything else is needed.

No deficiencies observed.

Exit interview conducted and a copy of report was given.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC809 (FAS) - (06/04)

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