392700368-10-19-2021-27-AS-BJAS-C7XK5Z-20211019073643

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 392700368
Report Date: 10/14/2021
Date Signed: 10/19/2021 07:36:58 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	COMMONS ON THORNTON, THE		FACILITY NUMBER:	392700368
ADMINISTRATOR:	MILLER, CAROL		FACILITY TYPE:	740
ADDRESS:	10711 THORNTON RD		TELEPHONE:	(209) 476-1500
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	110	CENSUS: 100	DATE:	10/14/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Carol Miller, Executive Director		TIME COMPLETED:	04:45 PM

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	Licensing Program Analyst (LPA) Bruce Jacobs, Licensing Program Managers Liza King and Stephanie Doub, Regional Manager Krystall Moore and Health Care Associated Infections (HAI) representative Hosniyeh Bagheri, Infection Preventionist, CDPH conducted an office visit via teams on 10/14/21 at 4:00pm with Commons on Thornton Administrator Carol Miller to discuss the recommendations provided by HAI following the onsite visit on 09/22/21. This Health and Safety visit is to ensure the facility is following the appropriate infection control protocols. HAI Summary and Recommendations Reviewed: · Facility was not aware of the response testing protocol. Response testing should be initiated as soon as one or more positive staff/resident identified in the facility and should be continued up to 14 days after the last positive case/s is identified. There should be at least 2 consecutive negative results for all staff and residents on the weekly basis testing and 14 days passed from the last positive. Please check with DSS and LPH for more information in this regard. · Consider to quarantine all negative residents until the termination of the outbreak and use appropriate PPE accordingly · Limit the visitation, group activities and communal dining as per your mitigation plan during the outbreak. · Consider to cohort staff for positive residents and non-positive ( Exposed residents) if possible Continued... Page 1 of 3

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce Jacobs	TELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: COMMONS ON THORNTON, THE	FACILITY NUMBER: 392700368
	VISIT DATE: 10/14/2021

NARRATIVE

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· Make ABHR dispensers available at the POC, they can be installed outside of the resident’s rooms, if there should be a risk for consumption of ABHRs by residents then they can be placed in isolation carts. Staff can also be provided with the small pocket size bottles. It is important for the staff to perform HH before and after care regardless of donning gloves.
· It is recommended to do active screening for all staff and visitors upon reporting to their shift including verifying vaccination status from all visitors and staff.
· Refer to PIN 21-40, vaccination status verification and testing requirement for visitors for further information.
· Exposed residents (Covid-19 negative) are not quarantined and staff do not put on full PPE for the contact with these residents. It is recommended to consider the whole unit exposed and place the residents under quarantine until 14 days of the last positive staff and /or resident in the unit. Full PPE including gown and gloves is necessary when staff take care for these resident
· There is an isolation sign on the resident’s door but the instruction of the infection control practices such as hand hygiene and use of PPE are not included on the sign. It is recommended to have these information on the sign displayed on isolation room to remind and educate staff on necessary infection control practices. Sample sign is attached to the email of this report that facility may consider using them.
· Facility uses premix disinfectant from echo lab for environmental cleaning and disinfection from. Consider to review cleaning/ disinfection products from EPA List N that has the list of disinfectant agents against Covid-19 including the information regarding contact time. Assure if staff is aware of the disinfectant products contact time. Label the containers with a large print with the name of the product, and contact time and expiration date if applicable for easy reference for staff who uses the products. Removed trash bags should be directly disposed in dumper, do not leave them on the floor to avoid the surfaces and floor contamination. Continued Page 2 of 3

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce Jacobs	TELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: COMMONS ON THORNTON, THE	FACILITY NUMBER: 392700368
	VISIT DATE: 10/14/2021

NARRATIVE

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· Make sure all high touch surfaces are cleaned and disinfected regularly. Provide staff with the list of high-touch surfaces and avoid cross contamination throughout the process of cleaning. The educational flipcharts are attached to the email of this report to use for staff education.
· Use microfiber cleaning cloths versus the cotton towels for environmental cleaning/ disinfection. Microfiber comprised of densely constructed synthetic strands and cleans 50% better than comparable cotton
· Don gloves before the care or task after performing HH and remove immediately after completing the task. Instruct staff to not carry gloves in their pocket to avoid contamination of clean gloves
· Establish a mechanism for identifying clean vs contaminated equipment such as bagging, tagging, signage or designated space to assure equipment are only used after they are cleaned and disinfected
· Continue N95 respirator fit testing for all staff prioritizing the clinical staff. Educate staff to perform seal check every time they put on respirator. Check this video at CDC for further information Donning (Putting on) and Doffing (Taking off) and User Seal Checks Video
· Make sure that N95 respirators are used without combining with any other masks.
· Consider to use adherence monitoring tools for infection control practices such as Hand hygiene, environmental cleaning, PPE donning/doffing, and Fluorescent marker utilization to monitor environmental cleaning. You can find CDPH Adherence Monitoring Tools at CDPH website
· As the mitigation strategies are difficult to implement in the memory care setting, refer to “COVID-19 and Memory Care Units Reference Sheet” attached to the email for some information about managing Memory Care residents.

Facility Evaluation Report provided to the Facility Administrator. Signed by Debbie Warren.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce Jacobs	TELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

LIC809 (FAS) - (06/04)

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