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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001594
Report Date: 11/06/2023
Date Signed: 11/06/2023 10:29:14 AM


Document Has Been Signed on 11/06/2023 10:29 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 ELDERLYFACILITY NUMBER:
347001594
ADMINISTRATOR:VINLUAN, LITAFACILITY TYPE:
740
ADDRESS:8208 SUMMER FALLS CIRCLETELEPHONE:
(916) 682-3942
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:5CENSUS: 3DATE:
11/06/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Lita VinluanTIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Pang Lee arrived unannounced to conduct a health and safety case management visit. The facility is on quarterly visits due to non-compliance concerns discussed during an zoom meeting on 05/17/2023. LPA Lee met with licensee, Lita Vinluan and explained the purpose of the visit. The census is 3 with one facility staff.

At 8:15 AM, LPA Lee entered the facility, LPA Lee observed two resident sitting in the common area watching TV and one resident sitting in the dining table eating breakfast. LPA Lee spoke to 3 residents and 3 residents appeared to be cleaned and comfortable. At 8:45 AM, LPA Lee toured the physical plant to ensure compliance with Title 22 regulations. LPA Lee observed and can hear administrator dogs inside the administrators bedroom barking. LPA Lee observed four small dogs and three cats in the facility. LPA Lee observed resident bedrooms, bathrooms, common areas, exterior plant, garage and storage shed. LPA Lee observed resident bedrooms to have the necessary furniture and furnishings. Bedrooms were equipped with a bed, chair, dresser, and closet space. LPA Lee observed resident bedroom #3 sliding door is missing; therefore, the licensee did not ensure to keep the facility free of flies and other insect. Resident bathroom was stocked with toilet papers, paper towels, and soap. Resident bathroom also had hand rails and non-slip mat. Temperature inside the home is 72*F. Hot water temperature was measured at 113.5*F. LPA Lee observed the fire extinguisher located in the kitchen next to the china cabinet. The fire extinguisher was last serviced on 08/18/2023. The carbon monoxide was in good repair. LPA Lee observed no emergency exits was obstructed and the fire alarm is in good repair. LPA Lee observed chemicals were made inaccessible to residents in care. LPA requested to review resident files and staff files. LPA Lee reviewed 3 out of 3 resident files and 2 out of 2 staff files and they were all complete. LPA Lee reviewed and compared 3 out of 3 medication administration record (MAR) and residents medications and it was complete and accurate. The first aid kit was checked and contained all of the required components.

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: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 11/06/2023 10:29 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: 11/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2023
Section Cited
CCR
80087(a)(1)

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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
(1) The licensee shall take measures to keep the facility free of flies and other insects.
This requirement was not met as evidence by:
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The licensee agrees to replace or purchase a sliding window screen for resident bedroom #3. The licensee agrees to conduct Building and grounds training and Licensee will also write a statement of acknowledging that all facility Staff have read and understood regulation being cited today. The licensee will send LPA Lee copies of the training agenda and sign in sheet of all staff that attended the training to LPA Lee at pang.lee@dss.ca.gove by 11/17/2023 by 5:00 PM by end of day.
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Based on observations, the licensee did not ensure that resident bedroom #3 has a sliding screen; therefore, the licensee did not ensure the facility was free from insects, which poses a potential health and safety risk to residents in care.
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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: 11/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2