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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002676
Report Date: 09/23/2021
Date Signed: 09/23/2021 03:36:36 PM

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:WESTSIDE ASSISTED LIVINGFACILITY NUMBER:
455002676
ADMINISTRATOR:ENEIX, AUDRAFACILITY TYPE:
740
ADDRESS:915 HALLMARK DRTELEPHONE:
(530) 605-4041
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:6CENSUS: 6DATE:
09/23/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Gurmeel and Reema Singh-AdminsitratorsTIME COMPLETED:
03:30 PM
NARRATIVE
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On 09/23//2021, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced Case Management Health and Safety visit as directed by the department. LPA met with Administrator Licensee Gurmeel Singh and explained the reason for the visit. 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; contacted Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical masks. Additionally, LPA was screened by staff at the front door

LPA toured the facility inside and out including but not limited to facility dining areas, outside areas, staff break rooms, kitchen area. LPA observed that the facility has had some renovations done. The following renovations has been completed included; Bathroom remodeled, added counters, cabinets in the kitchen area, new flooring and painting throughout facility, a wall that has been removed, bedrooms and bathrooms has been added. LPA asked Licensee if there was a permit application on the changes to the facility. Licensee reported that “my architect is in the process of getting that completed.” LPA explained to Licensee that when there are any kind of alternations to the facility, licensee needs to report such changes and a permit completed prior to the remodel, which also needs to be approved as well as a fire inspection completed. Licensee reported that he was not aware of having to notify LPA but will from now on. LPA asked about residents in care and where have they been throughout the remodeling. Licensee reported that all residents in care have been removed from the facility in process of remodeling.

continue on 809-C
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
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 4
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: WESTSIDE ASSISTED LIVING
FACILITY NUMBER: 455002676
VISIT DATE: 09/23/2021
NARRATIVE
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LPA requested to see documentation that residents and families have been notified of the movements. Licensee reported that they never provided any documentation regarding the moves and that they have been in contact with all residents and their families verbally. LPA explained to Licensee that LPA will be citing Licensee regarding the unreported alternations in the facility, reporting requirements to LPA on changes, no fire clearance on renovations, and illegal evictions. Licensee understood and reported that he will contact LPA with any changes to the facility from here on out.

Deficiencies are cited on LIC 809D.

Exit interview conducted and a copy of report along with appeal rights were given.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: WESTSIDE ASSISTED LIVING
FACILITY NUMBER: 455002676
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2021
Section Cited

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Alterations to Existing Building or New Facilities (a)Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidence by:
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The licensee has made some alterations to the facility and did not seek approval from the licensing agency or the fire marshal, as required. This poses an as a otential health and safety risk to residents in care.
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Type B
10/01/2021
Section Cited

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All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department...or the State Fire Marshal. This requirement is not met as evidenced by:
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Based on LPA observation, licensee did not maintain a fire clearance to the alternations made at the facillity. This poses an as a otential health and safety 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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: WESTSIDE ASSISTED LIVING
FACILITY NUMBER: 455002676
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2021
Section Cited

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Eviction Procedures. (a) The licensee may evict a resident for one or more of the reasons listed ... This requirement was not met as evidenced by:
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all residents were moved during facility alterations and not given an approriate 60 day notice. This posed a potential risk to resident's personal rights.
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Type B
10/01/2021
Section Cited

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Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(1) A written report shall be submitted to the licensing agency and to the person responsible for the...
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This requirement has not been met as evidenced that the licensee did not sure that licensee reported alterations done to the facility This is a potential health, safety or personal rights risk to the 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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4