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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002829
Report Date: 08/25/2021
Date Signed: 08/25/2021 03:23:23 PM

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:VILLA LINDAFACILITY NUMBER:
347002829
ADMINISTRATOR:BACHIS, GAVRILFACILITY TYPE:
740
ADDRESS:6501 LINDA WAYTELEPHONE:
(916) 217-2056
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 1DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Liana BachisTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Melana Llopis arrived at the facility unannounced on 08/25/2021 to conduct a Required - 1 Year inspection. LPA met with Administrator, Liana Bachis and explained the purpose of the visit.
Prior to visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; upon entry LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by Administrator, upon entering the facility.

LPA and Administrator toured the physical plant together, areas inspected include but are not limited to the following: six (6) resident bedrooms and bathrooms, living room, kitchen, dinning area, backyard, and laundry room.
LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two day perishable and (7) seven day non-perishable food supply on hand. LPA observed that knives, cleaning products and other toxins were locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home was free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke detectors are operational and care home also has a carbon monoxide detector. Fire extinguishers and first aid kit are maintained and ready for emergency use.
LPA reviewed infection control procedures to ensure facility is in compliance.

LPA checked medication storage and found medication to be locked away and inaccessible to the residents.
LPA observed resident medication to be prepoured over 24 hours in advance.
LPA reviewed two resident files and one staff file.
As a result of today's visit, a deficiency is being cited on form 809D, per California Code of Regulations Title 22.
Exit interview conducted, copy of report and appeal rights provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: VILLA LINDA
FACILITY NUMBER: 347002829
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
97465(h)(5)
87465 Incidental Medical and Dental Care
(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.
This requirement was not met as evidenced by:
Deficient Practice Statement
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Based on observation, LPA observed during medication review, medications are being pre-poured more than 24 hours in advance. LPA observed medication is pre-poured for three (3) days. This poses a potential health and safety risk to residents in care.

POC Due Date: 09/01/2021
Plan of Correction
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Licensee agrees to cease pre-pouring medications more than 24 hours in advance. Additionally, letter of understanding to be sent to CCL by Plan of Correction date of: 09/01/2021.

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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021
LIC809 (FAS) - (06/04)
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