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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202817
Report Date: 09/05/2023
Date Signed: 09/29/2023 12:41:23 PM


Document Has Been Signed on 09/29/2023 12:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:VISTA HARDEN RANCHFACILITY NUMBER:
275202817
ADMINISTRATOR:CARTER, JOYFACILITY TYPE:
740
ADDRESS:290 REGENCY CIRCLETELEPHONE:
(805) 319-7370
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:83CENSUS: 77DATE:
09/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator, Joy CarterTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to Conduct a Case Management visit. LPA met with facility Administrator, Joy Carter and explained the purpose of today's visit.

LPA Hurt observed the door to Resident 1's bedroom open and resident was in bed exposed to the common area where other facility residents were sitting watch television. LPA Hurt observed Staff 1 near the area and called for them to close the door to Resident 1's room area. LPA Hurt observed Staff 1 did close the door.

The following Deficiencies are being cited Per Title 22 Regulations

Exit interview conducted with Administrator Joy Carter and a copy of this report provided.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023
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 09/29/2023 12:41 PM - 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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: VISTA HARDEN RANCH
FACILITY NUMBER: 275202817

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2023
Section Cited
CCR
87468.1(a)

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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
The following requirement has not been met as evidenced by:
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Administrator Joy will conduct Personal rights training with facility Memory Care staff, and submit proof to LPA Hurt by POC date of 09/19/23.
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Based on LPA observation Resident 1 was fully exposed to residents in common area which poses a potential, heakth, safety, or personal rights risk to residents in care.
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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: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023
LIC809 (FAS) - (06/04)
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