045002811-8-9-2023-59-AS-JBOS-CUJPF6-20230809111612

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045002811
Report Date: 08/09/2023
Date Signed: 08/09/2023 11:16:30 AM

Document Has Been Signed on 08/09/2023 11:16 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	CARMEL HOUSE		FACILITY NUMBER:	045002811
ADMINISTRATOR:	STRICK, KATHERINE		FACILITY TYPE:	740
ADDRESS:	6 CARMEL PLACE		TELEPHONE:	(530) 343-8007
CITY:	CHICO	STATE: CA	ZIP CODE:	95973
CAPACITY:	6	CENSUS: 5	DATE:	08/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Administrator- Jeanine Murphy		TIME COMPLETED:	11:30 AM

NARRATIVE

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On 08/09/2023, Licensing Program Analysts (LPAs) Jaynae Boyles and Kerry Hiratsuka arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPAs met with Facility Administrator,Jeanine Murphy and explained the purpose of the visit.

LPAs Boyles, Hiratsuka and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, backyard, shed, and common restrooms. LPA's observed the facility to be clean, in good repair and odor-free and each bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids and 20-second hand-washing poster. Facility has a 2-day perishable and a 7-day non-perishable amount of food. Hot water temperature was measured at 118 F. LPA observed three (3) fire extinguishers, fire detectors, and carbon monoxide detectors.

LPA reviewed a total of three (3) residents' files and 3 staff files.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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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Document Has Been Signed on 08/09/2023 11:16 AM - 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CARMEL HOUSE	FACILITY NUMBER: 045002811
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87307(d)(6)

Personal Accommodations and Services

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 by the resident bed blocking the exit which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/10/2023
	Plan of Correction
1 2 3 4	Administrator stated the bed will be moved to no longer block the door.

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.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/09/2023 11:16 AM - 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CARMEL HOUSE	FACILITY NUMBER: 045002811
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87412(c)(2)

Personnel Records

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above the administrator did not provde or document training for facility staff after the year 2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2023
	Plan of Correction
1 2 3 4	THe administrator will determine a training and documentation schedule to ensure that all staff meet the training requirements.

Type B

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 interview and record review], the licensee did not comply with the section cited above the administrator stated that there has not been a emergency drill since 9/2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2023
	Plan of Correction
1 2 3 4	The administrator will determine an emergency drill schdule and document when emergency drills are reviewed and completed

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

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CARMEL HOUSE	FACILITY NUMBER: 045002811
	VISIT DATE: 08/09/2023

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The following deficiencies were observed and cited:
-bed blocking an exit to the outside. Immediate civil penalties of $500.00 issued today. Exits to the outside cannot be blocked and is a fire safety issue
-no current staff training logs. The last training log for staff was 2022. Staff are required to have annual training and it needs to be logged.
-no current emergency evacuation drills. Per Title 22 regulations emergency evacuation drills are to be done quarterly for each shift.

Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights left $500.00 immediate civil penalties were issued

Exit interview conducted and copy of report left at the facility.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC809 (FAS) - (06/04)

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