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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700573
Report Date: 12/10/2021
Date Signed: 12/10/2021 02:04:46 PM

Document Has Been Signed on 12/10/2021 02:04 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:AKUA BEHAVIORAL HEALTH INC IVFACILITY NUMBER:
342700573
ADMINISTRATOR:BEZDEK, SEANFACILITY TYPE:
772
ADDRESS:10821 & 10827 FAIR OAKS BLVDTELEPHONE:
(916) 903-7028
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 14CENSUS: 7DATE:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Miriam Whyman, Compliance Manager and Sean Bezdek, Regional Manager TIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPA's) Sabrina Calzada and Cassie Yang, arrived unannounced to conduct a required annual. LPA met with Miriam Whyman, Compliance Manager, and Sean Bezdek, Regional Manager, and explained purpose of inspection. LPA's completed required COVID-19 testing protocols and completed daily assessment and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA's were screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. The facility is a social rehabilitation facility that is licensed for (14) residents. Typical length of stay for residents is (14) days. There are (2) separate buildings licensed by the Department. The facility has an approved mitigation plan. LPA's were informed that all (7) residents were on an outing during the time of the inspection.

LPA's and managers toured the interior of both buildings and the outside areas. LPA's observed the facility to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters, sanitizer and PPE throughout the buildings. LPA's observed paper towels, soap and hand-washing poster in restrooms. Fire extinguisher last serviced 12/10/2020- will renew by tomorrow and send documentation. LPA's observed 2+day perishable and 7+day non-perishable food and all sharps and toxins to be locked. LPA's and and Administrator discussed the vaccination status of residents/staff as well as visitation protocols per PIN 21-40. Administrator to possibly post signage at the front entrance that masks, documentation of vaccination status or negative Covid test within 72 hours are required upon entry- Facility does not have a lot of visitors outside of care/service providers.

LPA requested an updated copy of LIC308 be sent to the department by 12/17/2021.

There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator who was informed that a subsequent annual inspection could be conducted on/around 2/13/2022.


SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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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