397002682-8-2-2023-27-AS-MJEN-CUBTVE-20230802150349

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 397002682
Report Date: 08/02/2023
Date Signed: 08/02/2023 03:04:19 PM

Document Has Been Signed on 08/02/2023 03:04 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	SUNNY PLACE OF STOCKTON		FACILITY NUMBER:	397002682
ADMINISTRATOR:	EXPECTACIO VIERRA		FACILITY TYPE:	740
ADDRESS:	807 WEST SWAIN ROAD		TELEPHONE:	(209) 956-8677
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	18	CENSUS: 10	DATE:	08/02/2023
TYPE OF VISIT:	Case Management - Legal/Non-compliance	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Expectacion Vierra		TIME COMPLETED:	02:35 PM

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On 8-2-23 at 2pm, a meeting was held with Licensee to review previous engagements by Department’s Technical Support Program (TSP). This meeting was held virtually via Teams Meeting. Present at this meeting were Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Maja Jensen, and Licensee Expectacion Vierra. Topics discussed in this meeting included (1) Care and Supervision, (2) Record Keeping, (3) Incident Reporting (4) Needs and Service Plans, (5) Training Requirements

TSP conducted engagement meetings with Licensee on the dates of 4/5/23, 4/12/23, and 4/19/23. TSP addressed care and supervision through providing tools for Needs and Service Plan Development. The Licensee advised the TSP representative that since the non-compliance conference there has been increases to supervision, administrator coverage has increased to 40 hours per week and resident assessments have been updated as February 2023. The licensee was encouraged to document all training efforts and at a minimum to identify the trainer, and include the date, contents, participants and length of the training. Use of the Ombudsman for personal rights training and home health providers was discussed as potential resources for conducting training. The Licensee was encouraged to develop a job aid for kitchen staff to easily recognize the dietary needs of all residents with a modified diet and agreed to do so.

TSP addressed record keeping as an area of focus for Licensee due to history of non-compliance. TSP addressed the challenges with licensee conducting and documenting resident assessments and re-assessments. TSP provided training resources and other recommendations to aid in Licensee’s future compliance with this regulated section.

Licensee stated during the meeting that she has a staff member that is currently pursuing training for Administrator Certification and she intends to have this staff member take responsibility for record keeping.

Continued on LIC 809C...

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUNNY PLACE OF STOCKTON	FACILITY NUMBER: 397002682
	VISIT DATE: 08/02/2023

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TSP made recommendations for Post-Engagement to assist in facility operation and compliance with laws and regulations. The recommendations include:

• Subscribe to CCLD information sharing service.

• Complete a facility self-assessment on at least a quarterly basis and record actions taken when issues are identified, maintain a record of assessments and ensure they are available upon request of the CCLD.

• Follow recommendations provided by TSP in this Engagement Summary Report and document and retain records showing efforts toward facility compliance in areas of focus.

• Review and comply with all laws and regulations specific to the operation of an RCFE.

• Review resources, guides, Provider Information Notices, websites, etc., provided in this report and use to aid in compliance.

• Use the resources provided through the engagement process for staff training and implementation of changes. Document and retain records of training in the facility file.

• Consider affiliating with a provider organization or network.

• Consider employing the services of a CDSS-approved administrator certification training program vendor to support the remediation of chronic issues, implement long-term solutions, and provide ongoing support services.

Licensee was made aware that quarterly visits will continue at this time to ensure the compliance with above and overall regulatory compliance.

No citations issued as a result of today’s visit. An exit interview was conducted with Licensee Expectacion Vierra and a copy of this report was emailed to Licensee with a request to return with signature.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC809 (FAS) - (06/04)

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