Community Care Licensing

Document Has Been Signed on 04/27/2023 03:09 PM - It Cannot Be Edited

FACILITY NAME:	TENDER TOUCH RESIDENTIAL CARE HOME III		FACILITY NUMBER:	075601264
ADMINISTRATOR:	CRUZ, ESTRELLITA S.		FACILITY TYPE:	740
ADDRESS:	2130 DORSCH ROAD		TELEPHONE:	(925) 256-6879
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY: 6		CENSUS:	DATE:	04/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee Estrellita Cruz		TIME COMPLETED:	03:30 PM

SUPERVISORS NAME: Harpreet Humpal LICENSING EVALUATOR NAME: James Sampair LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023

Link to Parent Document Below:

FACILITY NAME: TENDER TOUCH RESIDENTIAL CARE HOME III	FACILITY NUMBER: 075601264
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2023

Type B

Section Cited

CCR

87208(a)(7)(B)

87208 PLAN OF OPERATION (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility ... shall contain the following: (7) Sketches ... (B) The grounds showing buildings, driveways, fences, storage areas, pools, gardens, recreation area and other space used by the residents. 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 in 2 out of 2 facility sketches, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/04/2023
	Plan of Correction
1 2 3 4	Licensee shall create and post the floor plan and yard sketches accurately depicting the facility and inform the LPA on or before the due date.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: James Sampair LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023

Link to Parent Document Below:

FACILITY NAME: TENDER TOUCH RESIDENTIAL CARE HOME III	FACILITY NUMBER: 075601264
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2023

Type A

Section Cited

CCR

87309(a)

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 in the bathroom cabinet where cleaning supplies stored, which posed an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Cleared during visit when staff locked cabinet door.

Type A

Section Cited

CCR

87309(b)

(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above. 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 in 1 out of 1 refrigerated medication storage locations that must be locked, which posed an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Cleared during visit when staff locked and removed key from refrigerator.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: James Sampair LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023

Link to Parent Document Below:

FACILITY NAME: TENDER TOUCH RESIDENTIAL CARE HOME III	FACILITY NUMBER: 075601264
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2023

Type A

Section Cited

CCR

87555(b)(25)

(b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. 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 in the garage where laundry soap was stored next to food (Ensure], which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Cleared during visit when staff moved laundry detergent to locked cabinet.

Type A

Section Cited

CCR

87705(f)(1)

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 in the kitchen where staff stored scissors in an unlocked drawer, which posed an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Cleared during visit when staff removed scissors and placed them in a locking drawer.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: James Sampair LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023

Link to Parent Document Below:

FACILITY NAME: TENDER TOUCH RESIDENTIAL CARE HOME III	FACILITY NUMBER: 075601264
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/27/2023

Type B

Section Cited

CCR

87303(a)

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. 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 in the exterior of the facility, where a section of gutter was broken and left hanging above the threshold of the front porch and the front door leading into the facility, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2023
	Plan of Correction
1 2 3 4	During the visit, staff blocked access there and directed visitors to alternative entrances for a temporary solution. Licensee shall have gutter professionally repaired on or before due date. Licensee shall send proof of repair to LPA on or before due date.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: James Sampair LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023