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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001567
Report Date: 09/12/2022
Date Signed: 09/12/2022 02:22:16 PM


Document Has Been Signed on 09/12/2022 02:22 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,
, CA



FACILITY NAME:A BRAND NEW DAYFACILITY NUMBER:
455001567
ADMINISTRATOR:TAORMINO, BRITTNIEFACILITY TYPE:
740
ADDRESS:779 KERRY-JEN COURTTELEPHONE:
(530) 223-1538
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:26CENSUS: 12DATE:
09/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Mary Burger - LicenseeTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Ruth Wallace arrived unannounced to conduct an Required 1 Year Annual Inspection on 09/12/22. LPA met with Licensee. There are currently 12 residents who reside at this facility. This facility has a hospice waiver for 6 residents and currently 0 residents are receiving hospice care.

Licensee toured the facility with LPA. There are two separate buildings on the property, each building has 8 resident bedrooms, kitchen, and common areas. LPA inspected the interior and the exterior of the facility including the common living spaces, 8 resident bedrooms and 4 bathrooms, kitchen and staff areas. Bathrooms and bedrooms were clean and in good repair. LPA toured the backyard and facility has an approved delayed egress system with secured perimeter There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed an adequate amount of linens and found the first aid kit to be complete. LPA observed the smoke/monoxide alarms to be in working order and the fire extinguishers are fully charged which expire 10/6/2022. Facility is conducting quarterly fire drills and the last one was conducted 08/15/2021. The hot water measured 107.3*F which is within the required range of 105-120*F. LPA observed sufficient supply of linens/towels/blankets and a complete first aid kit. LPA reviewed 4 of 12 resident records and LPA reviewed medications of two residents comparing with Centrally Stored Medication Record and physician orders. LPA reviewed 3 staff records and 2 are missing health screen and TB results. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated 1 staff is missing current first aid certificate.

There were deficiencies found during today’s inspection. Deficiencies are cited from California Code of regulations, Title 22, and citations are listed on the attached LIC809D. If the deficiencies are not corrected by the noted due date civil penalties may be assessed.Exit Interview conducted with Licensee. LPA left copies of reports and appeal rights with Licensee.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022
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 2


Document Has Been Signed on 09/12/2022 02:22 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,
, CA


FACILITY NAME: A BRAND NEW DAY
FACILITY NUMBER: 455001567

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)(11)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in Staff #1 and #3 were missing health screens and TB results. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2022
Plan of Correction
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Licensee agrees to submit via email to Licensing Program Manager Laura Munoz copies of health screens and TB results for staff #1 and #3.
laura.munoz@dss.ca.gov
Type B
Section Cited
CCR
87411(c)(1)
Personnel Requirements - General
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation , the licensee did not comply with the section cited above in Staff #2 is missing current first aid certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2022
Plan of Correction
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Licensee agrees to submit via email to Licensing Program Manager Laura Munoz copy of Staff #2's current first aid certificate.
laura.munoz@dss.ca.gov

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: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022
LIC809 (FAS) - (06/04)
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