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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002486
Report Date: 09/13/2022
Date Signed: 09/13/2022 12:55:29 PM


Document Has Been Signed on 09/13/2022 12:55 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:VETERANS HOME OF CALIFORNIA-REDDINGFACILITY NUMBER:
455002486
ADMINISTRATOR:EISZELE, PAMELAFACILITY TYPE:
740
ADDRESS:3400 KNIGHTON ROADTELEPHONE:
(530) 224-3300
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:93CENSUS: 81DATE:
09/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Pam Eiszelle - AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required 1- Year Annual Inspection Visit and met with. Prior to initiating the 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask and gloves. Additionally, LPA was screened by front desk security.

LPA Wallace and administrator toured the facility inside and out including but not limited to facility front entrance, living room, resident bathrooms, kitchen area, outside area, outside resident bedrooms, storage rooms, and medication room. All passageways are free of obstruction. LPA observed the smoke/monoxide alarms to be in working order and the fire extinguishers are fully charged which expire 1/24/2023. Facility is conducting quarterly fire drills and the last one was conducted 8/16/2022. The hot water measured 106.3*F which is within the required range of 105-120*F. All staff were observed to be wearing surgical masks. Facility entrance is equipped with proper COVID-19 signage and screening station. Facility has a mitigation plan in place should a COVID positive case occur. Facility has sufficient supply of perishable food, non-perishable food, medication, and PPE.

LPA reviewed 6 of 81 resident records and LPA reviewed medications of 2 residents comparing with Centrally Stored Medication Record and physician orders. LPA reviewed 4 staff records and all have 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 all have current first aid certificates.

LPA Wallace completed infection control domain and observed no issues or concerns.


No deficiencies cited today from California Code of regulations, Title 22.

Exit interview conducted with administrator and a copy of report was provided.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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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