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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001567
Report Date: 04/28/2022
Date Signed: 04/28/2022 06:06:39 PM


Document Has Been Signed on 04/28/2022 06:06 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:A BRAND NEW DAYFACILITY NUMBER:
455001567
ADMINISTRATOR:TAYLOR, VERNAFACILITY TYPE:
740
ADDRESS:779 KERRY-JEN COURTTELEPHONE:
(530) 223-1538
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:26CENSUS: 14DATE:
04/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Mary Burger, LicenseeTIME COMPLETED:
06:30 PM
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On 4/28/2022 at approximately 10:30 AM, Community Care Licensing (CCL) Licensing Program Analysts (LPA) Jaclyn Avila, David Loperena, Misty Valencia and Regional Manager (RM) Alycia Berryman arrived at the facility unannounced to conduct a case management visit to tour the facility, LPAs and RM met with Licensee Mary Burger and explained the purpose of the visit. Prior to initiating the Tour, LPAs completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask and N95.

At time of entry, CCL staff were not screened for COVID 19 symptoms. CCL observed a resident (Room #3) and visitor enter the facility without being screened for signs and symptoms of COVID 19. CCL observed the facilities designee and administrator Syed Majid not wearing the surgical mask over the nose as required as.

At 11:04 AM, CCL observed an unsecured and accessible storage space containing office supplies which included white board cleaner and AquaSafe Plus Conditioner. Ingredients include sodium thiosulfate, chelating compounds, polyvinylpyrrolidones, organic hydrocolloids. This closet was in the hallway next to the admin office across from the resident dining area.

At 11:05 AM, CCL observed personal hygiene items in a community bathroom in the hallway near the dining rooms. CCL observed body wash in the cabinet, zinc paste and phytoplex ointment. CCL observed the physicians report (LIC 602) for resident 1 (R1). The LIC 602 indicated R1 is at risk if allowed direct access to personal grooming and hygiene items.

At 11:08 AM in a different community bathroom, CCL observed shampoo and conditioner under the sink.

Cont'd on LIC 809-C
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022
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 3


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: A BRAND NEW DAY
FACILITY NUMBER: 455001567
VISIT DATE: 04/28/2022
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At 11:09 AM, CCL observed multiple containers of protein powder in a community dining area. A container was on the top of the refrigerator unsecured and accessible. Off of this dining area was a walk in pantry with non-perishable food to include additional containers of protein powder. At the time of observation, residents were walking through the area.

At 11:11 AM, CCL observed a paper cutter on a book case in the activities room. The length of the blade is approximately 1.5 feet. At the time of observation there were two residents in the room unsupervised.

At 11:23 AM, CCL observed an unlocked staff storage room which contained employees personal belongings accessible to residents in care. In addition to personal items CCL observed a hoyer lift which could potentially be a tripping hazard to residents with a diagnosis of dementia.

At 11:33 AM and 11:34 AM, CCL observed 3 intake vents that were soiled with dark colored dust.

At 11:34 AM, CCL observed a baby gate secured with a bike lock in the entry way to the kitchen. The licensee said it was to prevent residents from gaining entrance into the kitchen due to there being knives and cleaning solutions.

At 2:21 PM in room #1, CCL observed an open faced space heater sitting on a wooden dresser. This heater contained warnings to keep away from combustible material such as furniture and clothes, failure to do so will result in fire and may cause death or personal injury. In the closet of this bedroom, LPA located a mini fridge. The mini fridge contained mold and foul odor. Licensee said she didn't know the mini fridge was in the closet.

At 11:44 AM, CCL observed a bruise on the left cheek bone of R2. Licensee said she did not know where it was from and stated it may have been caused by R1 who was sleeping in R2's bedroom. Licensee or administrator could not provide an incident report or explanation for the bruise.

LIC 610e displayed was dated 4/4/18. CCL requested an updated LIC 610 due by COB 4/29/2022.

The following deficiencies were cited per Title 22 of the California Code of Regulation (See 809D). Appeal Rights were explained and provided to the facility representative listed above and an Exit Interview was conducted. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/28/2022 06:06 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926


FACILITY NAME: A BRAND NEW DAY
FACILITY NUMBER: 455001567

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/29/2022
Section Cited

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87705(f)(1) Care of persons with dementia-The following shall be stored inaccessible to residents with dementia:(1) Knives, ... tools and other items that could constitute a danger to the resident(s).

This requirement is not met as evidenced by:
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 Based upon observation the Licensee failed to store items that could consititue a danger to 14 of 14 resident in care inaccessible.

This poses an immediate Health, Safety and/or Personal Rights risk to residents in care.
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Type A
04/29/2022
Section Cited

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87468.1(a)(2) Personal Rights of Residents in All Facilities-Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations
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This requirement is not met as evidenced by: Based upon observation the Licensee failed to provide 14 of 14 residents with safe, healthful and comfortable accommodations
This poses an immediate Health, Safety and/or Personal Rights 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: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022
LIC809 (FAS) - (06/04)
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