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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 126801871
Report Date: 03/21/2023
Date Signed: 03/21/2023 09:31:22 AM


Document Has Been Signed on 03/21/2023 09:31 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:ALDER BAY ASSISTED LIVINGFACILITY NUMBER:
126801871
ADMINISTRATOR:ANDERSON, SARAFACILITY TYPE:
740
ADDRESS:1355 MYRTLETELEPHONE:
(707) 444-8000
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:49CENSUS: 29DATE:
03/21/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Sara AndersonTIME COMPLETED:
09:45 AM
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At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a Case Management/Legal/Non-compliance visit. LPA met with Executive Director Sara Anderson and reviewed the areas of concern addressed in the Non-Compliance plan.

Building Maintenance: Facility did not ensure resident rooms were heated to at least 68 degrees Fahrenheit: Repairs have been completed to the boiler system and building temperature is maintained within regulation. Facility has back up heaters in case of future issues.
Injections: Facility staff gave an injection while not being a skilled professional: All medication staff have been trained on injections and medication management.
Staffing: Facility did not have sufficient dietary staff to ensure resident dining needs were met. Facility did not have sufficient care giving staff to ensure residents needs were met. Residents did not receive showers on scheduled days and resident laundry was not being washed in a timely manner: Facility has hired additional positions for the kitchen and has filled all level of care positions to ensure the resident needs are being met.
Activities: Facility did not have an activities program for residents. Activities Director has been hired. Facility has a printed monthly activities calendar that is updated with input from Resident council. Activities are conducted daily. LPA spoke with several residents who boasted they would have a difficult time to be bored at this facility with all the activities being offered.

No citations issued during this visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2023
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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