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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803028
Report Date: 07/28/2022
Date Signed: 07/28/2022 03:24:35 PM


Document Has Been Signed on 07/28/2022 03:24 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:AEGIS ASSISTED LIVING OF NAPAFACILITY NUMBER:
286803028
ADMINISTRATOR:PAUL OSESOFACILITY TYPE:
740
ADDRESS:2100 REDWOOD ROADTELEPHONE:
(707) 251-1409
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:56CENSUS: 46DATE:
07/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator, Paul OseoTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 07/28/2022 to conduct a Required-1 Year inspection. LPA met with administrator, Paul Oseso. This inspection was focused on the infection control practices and procedures of this facility. Facility is two stories with an assisted living section and a memory care unit. There are currently 14 residents in memory care and 32 in assisted living. Facility has 7 residents on hospice.

Upon entry LPA was screened using an automated Accushield screening system located at the front entrance. Screening tool is used for visitors, staff, and residents. Proof of vaccination is requested for indoor visitation. LPA and administrator discussed PIN 22-07. Residents are being screened daily for symptoms. Staff have been N95 fit tested and provided with infection control training. Updated guidance is communicated to families by administrator via email. Facility has sufficient personal protective equipment and supplies to support a resident in isolation. LPA toured facility with administrator. Building and grounds were clean and in good repair. Facility was a comfortable temperature and exits were free from obstructions. There are two locked medication carts as well as a centrally located storage area. Fire extinguishers were last checked on January 21, 2022. Communal dining is open for residents. LPA observed residents participating in group activities; dominoes and bingo. An activity schedule is available for the entire month of June. Infection control plan has been submitted to Community Care Licensing.

LPA requested the following documents be submitted to Community Care Licensing within 30 days of today's inspection: LIC 500 Personnel Report, LIC 9020 Resident Roster, LIC 308 Designation of Facility Responsibility, LIC 610 Emergency Disaster Plan for RCFE, and Evidence of Liability Insurance

No deficiencies observed during today's inspection.

Exit interview conducted with administrator, Paul Oseso and a copy of this report printed for the facility.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2022
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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