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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001594
Report Date: 08/18/2023
Date Signed: 08/18/2023 12:45:38 PM


Document Has Been Signed on 08/18/2023 12:45 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
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:CHRIS BEST CARE FOR ELDERLYFACILITY NUMBER:
347001594
ADMINISTRATOR:VINLUAN, LITAFACILITY TYPE:
740
ADDRESS:8208 SUMMER FALLS CIRCLETELEPHONE:
(916) 682-3942
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:5CENSUS: 3DATE:
08/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Lita VinluanTIME COMPLETED:
11:00 AM
NARRATIVE
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On 08/18/2023 at 8:00 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with , Licensee, Lita Vinluan and explained the purpose of the visit. Licensee assisted with today’s visit. Administrator certificate # is 6009565740 and will expire on 12/27/2023. Licensee called Another administrator, Christopher Vinluan who then arrived to the facility an hour later and joined the visit. The current census is 3 with 1 facility staff.

This facility is a single story building licensed to serve five (5) non-ambulatory residents. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to have pet odor smell. LPA Lee observed 5 cats and 5 dogs in the facility. LPA Lee observed the kitchen china glass cabinet observed to be clutter. LPA Lee also observed the hardwood floor by the kitchen is not in good repair. LPA Lee bathroom #1 and #2 did not have a non-slip mat. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. LPA Lee observed There are no bodies of water present.

LPA Lee observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 105.5 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire alarm is in good repair. Fire extinguishers and carbon monoxide detectors are not in compliance with fire safety. Fire extinguisher was last serviced on 06/16/2022. The carbon monoxide was observed to be broken and not working. Administrator added new batteries and it still was not working. Administrator stated that the last fire drill was conducted on March of 2022. LPA Lee observed the facility has a has a public telephone in the common room and the facility have the required posters posted. The facility has infection control plan and has an emergency disaster plan. Facility thermostat observed at 75 degrees Fahrenheit. Chemical was made accessible to residents in care. LPA Lee addressed the concern and observed administrator locked the chemical.
Continued LIC 809-C
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CHRIS BEST CARE FOR ELDERLY
FACILITY NUMBER: 347001594
VISIT DATE: 08/18/2023
NARRATIVE
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LPA Lee checked medication storage and found medication to be locked away and inaccessible to clients. LPA Lee reviewed 3 out of 3 medication administration record (MAR) and it was complete. First aid kit was checked and is complete. LPA Lee requested residents and staff files for review. LPA Lee reviewed 3 out of 3 resident files and 3 out of 3 staff files and they were complete. 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 email to LPA Lee (pang.lee@dss.ca.gov) by 08/22/2023 by 5:00 PM by end of day:

(1) LIC 308 Designation of Administrative Responsibility


(2) LIC 500 Personnel Report
(3) Copy of Administrator Certificate
(4) LIC 610 Emergency Disaster Plan
(5) Proof of Current Liability Insurance


As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies 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-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6
Document Has Been Signed on 08/18/2023 12:45 PM - 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833


FACILITY NAME: CHRIS BEST CARE FOR ELDERLY
FACILITY NUMBER: 347001594

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1569.311
Regulations
Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. Licensee did not ensure that the carbon monoxide decteor was in good repair, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/18/2023
Plan of Correction
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Licensee had another administrator replaced the carbon monoxide dector during today's visit. Licensee tested the carbon monoxide and it is now working. POC corrected during today's visit.
Type A
Section Cited
CCR
87202(a)
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Licensee did not ensure that the fire extinguisher tax is up todate. Fire Extinguishers tags expired on 6/16/2022 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/18/2023
Plan of Correction
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Licensee agreed to have fire extinguishers service during today's annual inspection visit. LPA's observed new fire extinguishers service on 08/018/2023 with new service tag attached. POC corrected during today's visit.
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-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6


Document Has Been Signed on 08/18/2023 12:45 PM - 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833


FACILITY NAME: CHRIS BEST CARE FOR ELDERLY
FACILITY NUMBER: 347001594

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
Maintenance and Operation
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above. The licensee did not ensure that the facility is clean, ordor free and in good repair, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2023
Plan of Correction
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Licensee agrees to clean and declutter the china glass cabinet. Licensee also agrees to replace the broken hardwood floor by the kitchen and eliminate the pet order smell and clean after the pets in the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6