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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700333
Report Date: 04/12/2021
Date Signed: 04/12/2021 09:47:46 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SAROAY, PARVEENFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106; 106CENSUS: 78DATE:
04/12/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Executive Director, Parveen SaroayTIME COMPLETED:
10:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Llopis contacted the facility unannounced on 04/12/2021 via telephone due to Covid19 and precautionary measures for a Case Management tele-visit. LPA spoke with Executive Director, Parveen Saroay and explained the purpose of the call.

On 10/26/2020 the Department received a complaint regarding allegations made against the facility. During LPA Llopis' investigation, it was found the facility had a scabies outbreak on 10/20/2020. On 03/29/2021 and 03/30/2021 LPA spoke with the Local Ombudsman and the Department of Public Health who stated there was no record of the facility reporting the scabies outbreak. During the month of October 2020, Community Care Licensing (CCL) did not receive a call regarding the scabies outbreak. LPA was first made aware of positive scabies case the day the complaint was reported. Further more, the facility could not provide a receipt of any fax sent to CCL. The Administrator confirmed no call was made to CCL to notify of the outbreak.

Deficiencies are being cited today due to the above information.

Deficiencies can be found on LIC809-D per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8.

Exit interview conducted with Executive Director, copy of report and appeal rights provided via email. Facility to print, sign and send a copy of signed report to CCL by 04/12/2021.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
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, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: FAIR OAKS ESTATES INC
FACILITY NUMBER: 342700333
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2021
Section Cited

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87211 Reporting Requirements
(a) Each licensee shall furnish to the licensing agency such reports as...
(2) Occurrences, such as epidemic outbreaks... which threaten the...safety or health of residents... shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate.
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This requirement was not met as evidenced by: the licensee did not report to CCL and to the local health office within 24 hours of the scabies outbreak in their community during the month of October 2020. This put a potential health and safety risk to residents in care.
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Letter of understanding and documentation of training provided with staff signatures is due to CCL by 04/26/2021.

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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: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2021
LIC809 (FAS) - (06/04)
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