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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280109377
Report Date: 06/29/2023
Date Signed: 06/29/2023 03:46:28 PM


Document Has Been Signed on 06/29/2023 03:46 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:VETERANS HOME OF CALIFORNIA TRUMAN HALLFACILITY NUMBER:
280109377
ADMINISTRATOR:THERESA JONESFACILITY TYPE:
740
ADDRESS:300 CALIFORNIA DRTELEPHONE:
(707) 948-2516
CITY:YOUNTVILLESTATE: CAZIP CODE:
94599
CAPACITY:48CENSUS: 28DATE:
06/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrator, Theresa JonesTIME COMPLETED:
03:55 PM
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Licensing Program Analyst Bertozzi arrived unannounced to conduct an Annual Required Inspection and met with Administrator, Theresa Jones.

LPA initiated a tour of the facility around 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in sinks accessible to residents in care measured at 113, 114 and 117 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Medications are stored in a medication room and inaccessible to residents in care. Cleaning supplies are stored in locked janitor closets and housekeeping carts. Facility has at least two days of perishable and one week of non-perishable foods that appeared to be of quality and was stored per regulation..

Fire extinguishers were last serviced January 2023. Carbon Monoxide detectors were tested and operational. Facility has a fire alarm system that is maintained by a vendor and the most recent inspection was conducted November 2022. Most recent fire/disaster drill was conducted 5/12/2023

Six staff files and eight resident files were reviewed. Staff have required First Aid and CPR certificates. Administrator Certificate for Administrator, Theresa Jones 6063677740 expires 8/22/2024. Medications and medication records were reviewed. Training records were reviewed. Required postings were observed.

Continued on LIC809C
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria BertozziTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: VETERANS HOME OF CALIFORNIA TRUMAN HALL
FACILITY NUMBER: 280109377
VISIT DATE: 06/29/2023
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Continued from LIC809

Administrator provided LPA a copy of their liability insurance.

Administrator to submit updates of the following documents by 7/29/2023:



LIC 610 Emergency Disaster Plan (If changes)
Infection Control Plan (If changes)

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria BertozziTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC809 (FAS) - (06/04)
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