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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700534
Report Date: 06/07/2021
Date Signed: 06/08/2021 09:57:41 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:SPLENDOR OF CARMICHAEL AT KEANE, THEFACILITY NUMBER:
342700534
ADMINISTRATOR:FOGGY, BRUCEFACILITY TYPE:
740
ADDRESS:4921 KEANE DRIVETELEPHONE:
(916) 514-9173
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 4DATE:
06/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Bruce Foggy, Maria WilliamsTIME COMPLETED:
11:00 AM
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On 6/7/2021 Licensing Program Analyst (LPA) Williams arrived unannounced at 9:15am to conduct an emergency case management visit. LPA toured the facility to assess the health & safety of the residents. Staff was wearing surgical mask and followed COVID precautions. LPA assessed the amount of food in the kitchen refrigerator, garage refrigerator and freezer. There was fruit, vegetables, and three packages of chicken, a large package of ground beef, a whole turkey, and fish. As LPA was touring the facility, Administrator S1 arrived at facility with a truck full of groceries from the grocery store, including vast quantities of meat, vegetables, dairy, etc. Administrator S1 began loading the groceries into the garage refrigerator as LPA interviewed residents.

LPA spoke with co-Administrator S2 says Administrator S1 called her at 5:15pm on 6/6/2021 and asked her to report to the facility (it was her day off). S2 arrived immediately. S2 says the two caregivers working at the time quit after receiving their paycheck from S1 around noon on 6/6/2021. When asked if there are other staff who can work at the facility, S2 stated there is herself, S1, and three other caregivers, but they will likely need to hire new caregivers now.

LPA spoke with Administrator S1. S1 explained the situation, stating that the caregivers quit when he had shown up to deliver their paychecks around noon on 6/6/2021. He then stayed at the facility until around 6:00pm, well after co-Administrator S2 had arrived. S1states he usually has two caregivers working despite the fact that there is only 4 residents in care, and the facility could easily get by with just one single caregiver working.

LPA spoke with W1 & W2, daughters of resident R1. The women stated they arrived at facility as visitors today to check on their father, R1, because they had also received texts from the caregivers who had texted licensing, so they wanted to assess the situation. They stated the caregivers told them there was not sufficient food.

LPA spoke with R1, who says he has only been in facility for a week (his family said he has lived in facility for roughly a year). R1 states he receives enough food and feels he could ask for more if he ever felt hungry. R1 states he has no complaints living here.

LPA spoke with R2, who states he receives adequate care and plenty of food living at the facility.

R3 was not willing to speak verbally with LPA.

There are no deficiencies being cited at this time. Report read to Administrator S1 and a a copy of the report provided to facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
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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