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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 126801871
Report Date: 12/13/2022
Date Signed: 12/14/2022 09:19:05 AM


Document Has Been Signed on 12/14/2022 09:19 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: DATE:
12/13/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Sara AndersonTIME COMPLETED:
03:30 PM
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Regional Manager Carla Nuti-Martinez, Licensing Program Manager Bethany Moellers, Licensing Program Analyst Chris Arnhold met with Tod Murray- Chief Operating Officer, Paula Wells-Regional Director of Operations, Sara Anderson- Executive Director. This meeting was conducted virtually.
This meeting is being conducted to address areas of concern. The following concerns were identified by the Licensing Agency in regard to the operation of this facility including but not limited to: Complaint investigations that have been substantiated and other concerns that have been observed such as:
Building Maintenance: Facility suffered a breakdown of the heating system, causing resident rooms to be heated to less than 68 degrees F. Emergency repairs were made to correct the issue.
Kitchen stove has damage which creates a safety hazard. Warming station is non-operational causing resident meals to be cool by the time they receive. Several freezers are non-operational. New Kitchen equipment has been researched and planned for in the budget.
Injections: Facility staff were provided training regarding injections. A staff training plan has been created to ensure all staff receive required annual training. Licensee understands only licensed professionals can provide injections to residents”. Per Regulation 87101 Definitions: Licensed Professional” means a person who is licensed in California to provide medical care or therapy. This includes physicians and surgeons, physician assistants, nurse practitioners, registered nurses, licensed vocational nurses, psychiatric technicians, physical therapists, occupational therapists and respiratory therapists, who are operating within his/her scope of practice.
Staffing: Facility has hired additional staff to ensure resident needs are met.
Activities: Activities Director has been hired.

An updated LIC500, Personnel Summary was requested during meeting.

No citations issued.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022
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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