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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286802019
Report Date: 07/19/2021
Date Signed: 07/19/2021 12:18:25 PM

Document Has Been Signed on 07/19/2021 12:18 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
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LINDA FALLS GUEST HOME 1FACILITY NUMBER:
286802019
ADMINISTRATOR:SACRO, NORBERTFACILITY TYPE:
740
ADDRESS:755 LINDA FALLS TERRACETELEPHONE:
(707) 963-1440
CITY:ANGWINSTATE: CAZIP CODE:
94508
CAPACITY: 6CENSUS: 5DATE:
07/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Norbert SacroTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Angela Elliott arrived unannounced to conduct an Annual inspection and met with Licensee Norbert Sacro. The inspection is focused on the Infection Control procedures and practices of this facility.

LPA was greeted by staff and Licensee. Upon entry LPA was screened there was a small table at the entrance with hand sanitizer and thermometer. Facility did not have a visitor sign in sheet. LPA discussed the importance of having a formal sign in sheet for visitors to document relevant information. LPA did not observe any information regarding facility's visitation policy. LPA and Licensee discussed the importance of having information for visitors to guide them. Mitigation plan has been submitted and approved by CCL.

Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is kept in the common areas and resident bedrooms at the facility. Per Licensee, they regularly discuss infection control with residents and staff. Changes in protocol are communicated to responsible parties via phone. Staff have completed Personal Protective Equipment (PPE) training. LPA and Licensee discussed the importance of staff completing infection control training. Licensee indicated staff have been N-95 Fit tested. Facility is cleaned daily and high touch surfaces are cleaned more frequently. During walk through LPA noted a lack of paper towels in restroom. LPA discussed the importance of not having shared towels for people to use to dry their hands. LPA also noted hallway to resident bedrooms downstairs was dark as light bulb needed to be replaced. LPA and Licensee discussed alternative lighting options while searching for light bulb.

(Continued on LIC 809-C)
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Angela Elliott
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2021
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
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LINDA FALLS GUEST HOME 1
FACILITY NUMBER: 286802019
VISIT DATE: 07/19/2021
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LPA reviewed resident temperature screening logs. Resident's emergency contact information has been updated, and Licensee confirmed staff are familiar with 911 procedures and protocols. Toxins are secured and inaccessible in locked cabinets. Medications are stored in a locked cabinet making them inaccessible to residents and facility had a 30 day supply of medications. The facility has a large supply of Personal Protective Equipment (PPE) and hygiene supplies. All exit alarms on exit doors were working properly. Facility is conducting COVID-19 surveillance testing per CCL guidelines. Licensee stated that the facility is following and operating in compliance with their approved mitigation plan.

Residents sit in preferred areas of the facility for dining. Common areas are also set up for social distancing. LPA and Licensee discussed client activities and visitation. Currently visits are happening in common areas or outside and facility offers activities during the day for those wanting to participate including, coloring, crossword puzzles, and exercise time.

Licensee and LPA discussed their Emergency Disaster Plan and confirmed it is current.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Angela Elliott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC809 (FAS) - (06/04)
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