275202817-12-12-2023-24-AS-SHUT-CYFU4C-20231212141455

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 275202817
Report Date: 12/05/2023
Date Signed: 12/12/2023 02:14:59 PM

Document Has Been Signed on 12/12/2023 02:14 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 RANCH		FACILITY NUMBER:	275202817
ADMINISTRATOR:	CARTER, JOY		FACILITY TYPE:	740
ADDRESS:	290 REGENCY CIRCLE		TELEPHONE:	(805) 319-7370
CITY:	SALINAS	STATE: CA	ZIP CODE:	93906
CAPACITY:	83	CENSUS: 73	DATE:	12/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Office Manager, Maria Perez		TIME COMPLETED:	06:30 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analysts (LPA's) Sarah Hurt and Lisa Salazar conducted an unannounced visit today for the facility’s annual inspection. LPA's met with Business Office Manager, Maria Perez Continual Administrator's Certification for Joy Carter expires 01/11/2025. There are currently 73 residents who reside at this home and there is 11 residents on hospice at this time. LPA's inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The facility has a carbon monoxide detector. Water temperature was tested at 113 degrees. Toxins and cleaning supplies are locked and inaccessible. Facility dementia training records and updated and complete. LPA's ensured all facility staff is background cleared.

LPA's observed the kitchen ice machine has black discoloration on the top inside. LPA's observed the facility soda machine inside the kitchen needs cleaning.
LPA's observed first aid kits to be located throughout the facility, but not all are complete.

LPA's reviewed facility records for 4 Memory care residents. Resident 1, Resident 2, Resident 3, and Resident 4 did not have current updated medical assessments.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Office Manager, Maria Perez and copy of report left at facility

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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 2

Document Has Been Signed on 12/12/2023 02:14 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: 12/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87705(a)(5)

87705 Care of Persons with Dementia (a) This section applies to licensees who accept or retain residents diagnosed by a physician to have dementia. Mild cognitive impairment, as defined in Section 87101(m), is not considered to be dementia. (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 4 out of 4 Memory care residents record reviewed did not have a current updated medical assesment, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2023
	Plan of Correction
1 2 3 4	Administrator will audit all memoy care resident records and ensure all have a current updated medical assesment and send proof to LPA by POC date of 12/19/23.

Section Cited


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

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 Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2