347001594-8-13-2024-27-AS-PLEE-D84Q8K-20240813115651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347001594
Report Date: 08/13/2024
Date Signed: 08/13/2024 11:57:02 AM

Document Has Been Signed on 08/13/2024 11:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	CHRIS BEST CARE FOR ELDERLY		FACILITY NUMBER:	347001594
ADMINISTRATOR:	VINLUAN, LITA		FACILITY TYPE:	740
ADDRESS:	8208 SUMMER FALLS CIRCLE		TELEPHONE:	(916) 682-3942
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	5	CENSUS: 4	DATE:	08/13/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:57 AM
MET WITH:	Lita Vinluan		TIME COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 08/13/2024 at 9:45 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with Licensee/Administrator Lita Vinluan and explained the purpose of today’s visit. Administrator assisted with today’s inspection. Administrator Certificate # 7034595740 expires on 12/27/2025. The current census is 4 with 2 facility staff. This facility is a single story building licensed to serve five (5) non-ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, staff room, shed, garage and outside courtyards of the facility to ensure compliance with Title 22 regulations. It was observed the facility was free of odor, clean and in good repair. LPA observed resident bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. At 10:02 AM, LPA Lee observed a kitchen knife on the dish rack which was made accessible to residents in care. LPA Lee observed the facility had sufficient seven day non-perishable food supplies and 2 days perishable food supplies. Hot water temperature was measured at 111.0 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen and was last serviced on 07/24/2024. LPA observed the facility has a has a public telephone in the kitchen. Facility thermostat observed at 74 degrees Fahrenheit. LPA observed toxins located in the garage cabinet kept locked and inaccessible to residents. LPA checked medication storage and found medication to be locked away and inaccessible to clients. LPA reviewed and compared 5 out of 5 medication administration record (MAR) along with residents’ medications and they were complete. LPA asked to inspect the facility’s first aid kit and it was complete. LPA requested resident and staff files for review. LPA reviewed 4 out of 4 resident files and they were complete. LPA reviewed 2 staff files and they were complete. LPs interviewed 1 facility staff and 2 residents during today’s visit. Continued LIC 809-C

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHRIS BEST CARE FOR ELDERLY	FACILITY NUMBER: 347001594
	VISIT DATE: 08/13/2024

NARRATIVE

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LPA Lee reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility.

The following documents will be emailed to LPA Lee at pang.lee@dss.ca.gov by 08/16/2024 end of day 5:00 PM.

(1) LIC 308 Designation of Administrative Responsibility

(2) LIC 500 Personnel Report
(3) LIC 610 Emergency Disaster Plan
(4) Proof of Bond Insurance

As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809 D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 08/13/2024 11:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHRIS BEST CARE FOR ELDERLY	FACILITY NUMBER: 347001594
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87309(a)(1)

Storage Space

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation at 10:02 AM, LPA Lee observed a kitchen knife made accessible to residents in care. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/20/2024
	Plan of Correction
1 2 3 4	Licensee agrees to ensure that all dangerous items are lock and made inaccessible to residents in care at all time. Administrator will read the regulation cited and provided LPA Lee a letter of acknowledgement of reading and understanding the regulation cited. POC will be emailed to LPA Lee at pang.lee@dss.ca.gov by POC date 08/20/2024 by 5:00 PM end of day.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC809 (FAS) - (06/04)

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