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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600966
Report Date: 10/27/2021
Date Signed: 10/27/2021 04:41:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:BETTER LIVING OF WALNUT CREEKFACILITY NUMBER:
075600966
ADMINISTRATOR:GALERA, RUDOLPHFACILITY TYPE:
740
ADDRESS:1868 DANIELLE CTTELEPHONE:
(925) 938-8820
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 6DATE:
10/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Anabelle GaleraTIME COMPLETED:
04:53 PM
NARRATIVE
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Licensing Program Analyst (LPA) James Sampair conducted an infection control annual inspection and explained the purpose of the visit with Administrator (ADM) Anabelle Galera, who is the designated Infection control leader. LPA inspected the facility inside and outside. A certified administrator is on site at all times to oversee proper business operation and compliance with COVID-19 infection control practices.

LPA observed that 4 of the 4 staff present wore face masks at all times. All of the staff and residents were fully vaccinated. LPA observed a screening station located near the front entrance with hand sanitizer, a no-touch thermometer, visitor's log, and face masks as needed. LPA observed COVID-19 signs posted in common areas to promote hand washing and physical distancing. Staff documents temperature and health status for staff and residents on a daily basis. LPA discussed the mitigation plan with the Licensee, as well as their current COVID-19 infection control practices. The Licensee has conducted staff training on infection prevention, symptoms, transmission, as well as the proper donning and doffing of PPE and they have adequate PPE supplies on hand in case of an outbreak.

However, there were areas where the LPA provided Technical Assistance because the staff were not asking for or recording vaccination status for visitors, nor had FIT testing been completed for all staff members. The LPA gave the Licensee tasks to overcome those missing areas detailed in the Technical Assistance forms.

The room temperature of the facility was maintained at a comfortable temperature and hot water was within the safe temperature of 105 to 120 degrees Fahrenheit. There were sufficient food and water supplies in the kitchen refrigerators/freezers. Fire extinguishers were observed fully charged and last inspected in October 2021 and the Smoke and Carbon monoxide detectors were fully operational.

-------------Continued on LIC809-C---------------
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BETTER LIVING OF WALNUT CREEK
FACILITY NUMBER: 075600966
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87308(c)
Resident and Support Services
(c) General storage space shall be maintained for equipment and supplies as necessary to ensure that space used to meet other requirements of these regulations is not also used for storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, because the kitchen knives were not stored in a locked drawer, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2021
Plan of Correction
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Move knives to locked area and create a regular solution for the normal day-to-day storage of knives and other potentially dangerous objects in the kitchen. Take pictures of the knives stored in a safe location and send to LPA before POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BETTER LIVING OF WALNUT CREEK
FACILITY NUMBER: 075600966
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87555(b)(15)
General Food Service Requirements
(b) The following food service requirements shall apply: (15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above because food not properly labelled in regrigerator and freezer, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2021
Plan of Correction
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Label all food with date packaged or expiration date if removed from a larger package. Take pictures of the foods in all refrigerators and freezers and send to LPA before POC due date.
Type B
Section Cited
HSC
1569.695(a)(2)
Other Provisions
(a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above because there was no water for the emergency supplies, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2021
Plan of Correction
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A minimum of 27 gallons of water must be on hand in the emergency kit at all times. Take pictures of the water and send to LPA before POC due date.
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: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BETTER LIVING OF WALNUT CREEK
FACILITY NUMBER: 075600966
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.695(a)(7)(A)
Other Provisions
(a) In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (7) Procedures that address, but are not limited to, all of the following: (A) Provision of emergency power that could include identification of suppliers of backup generators. If a permanently installed generator is used, the plan shall include its location and a description of how it will be used. If a portable generator is used, the manufacturer’s operating instructions shall be followed.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above because the generator is located at another facility, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2021
Plan of Correction
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Move generator to the facility. Take pictures of the generator and send to LPA before POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: BETTER LIVING OF WALNUT CREEK
FACILITY NUMBER: 075600966
VISIT DATE: 10/27/2021
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LPA recorded the following deficiencies:, the details of which are in the LIC809-D citations.
  • Technical Assistance: 130 - Fit testing not completed and will be completed by November 15, 2021.
  • Physical Plant/Environmental Safety - Type A: 87308(c) - Kitchen knives were not stored in a locked drawer.
  • Food Service - Type B: 87555(b)(15) - Food not properly labelled in refrigerator and freezer.
  • Disaster Preparedness - Type B: 1569.695(a)(2) - Did not have emergency water on hand.
  • Disaster Preparedness - Type B: 1569.695(a)(7)(A) - Generator located at another facility.

Exit interview was conducted and a copy of this report and copies of the Appeal Rights were provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6