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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804119
Report Date: 04/12/2024
Date Signed: 04/12/2024 02:36:09 PM

Document Has Been Signed on 04/12/2024 02:36 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:RAMEILS SACRED CARE HOMES 2FACILITY NUMBER:
286804119
ADMINISTRATOR/
DIRECTOR:		JEFFERSON, JENEROFACILITY TYPE:
735
ADDRESS:1513 RIO GRANDETELEPHONE:
(310) 531-6049
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
95403
CAPACITY: 6CENSUS: DATE:
04/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:House Manager, Rowena RadanaTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analysts (LPAs) Julie Florio and Chris Arnhold arrived unannounced, to conduct a required 1-year annual inspection and were greeted by House Manager, Rowena Radana. Administrator, Jenero Jefferson was not present. House Manager contacted Administrator but he did not show up during the inspection. LPAs informed House Manager that the facility administrator shall be present a sufficient number of hours necessary to manage and administer the facility in compliance with applicable law and regulation.

LPAs initiated a tour of the facility around 9:00pm and observed the following: Facility was a comfortable temperature and passageways were free from obstructions. Water temperature in clients' bathroom measured at 110.8 degrees F which is within allowable range of 105 to 120 degrees F. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked.

Fire extinguisher was last serviced May 2023. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts regular disaster drills and the most recent drill was conducted January 2024.

At approximately 10:00am five staff files and five client files were reviewed. Staff have required First Aid and CPR certificates. All staff are missing documented training from a licensed professional for assisting client(s) with inhaler medications. Medications and medication records were reviewed as well as client P&I. Review of facility's Surety Bond showed that client P&I exceeds the amount covered on the Surety Bond. LPAs discussed with House Manager the need to increase the surety bond amount. LPAs observed one resident missing a care plan necessary to address behaviors.

Continued on LIC809-C
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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 04/12/2024 02:36 PM - It Cannot Be Edited


Created By: Julie Florio On 04/12/2024 at 01:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: RAMEILS SACRED CARE HOMES 2
FACILITY NUMBER: 286804119

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85064(e)
Administrator Qualifications and Duties
(e) The administrator shall be on the premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interviews conducted and records reviewed, the licensee did not comply with the section cited above. Administrator is not present at the facility to ensure compliance with regulation, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/19/2024
Plan of Correction
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LIcensee to submit written plan to show the days and times the admiistrator will be present at the facillity. Written plan shall be submitted to CCL by POC date of 04/19/2024.
Type B
Section Cited
CCR
80075(b)(1)(A)
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. (1) In adult CCFs, facility staff who receive training may assist clients with metered-dose inhalers, and dry powder inhalers if the following requirements are met: (A) In ARFs, facility staff must receive training from a licensed professional.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 5 out of 5 staff records reviewed did not contain evidence of documented training regarding inhalers, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/10/2024
Plan of Correction
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LIcensee to submit proof of completed staff training from a licensed professional regarding inhalers to CCL by POC date of 05/10/2024.
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:Bethany Moellers
LICENSING EVALUATOR NAME:Julie Florio
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


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: RAMEILS SACRED CARE HOMES 2
FACILITY NUMBER: 286804119
VISIT DATE: 04/12/2024
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Documents needing to be updated include, but are not limited to, the following:

Surety Bond and LIC400 to reflect accurate amount of cash that is being safeguarded.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with House Manager and Appeal Rights were given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC809 (FAS) - (06/04)
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