<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803540
Report Date: 06/28/2022
Date Signed: 06/28/2022 02:14:56 PM

Document Has Been Signed on 06/28/2022 02:14 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PEOPLE'S CARE MORNING SUNFACILITY NUMBER:
486803540
ADMINISTRATOR:HENRY, STEPHANIEFACILITY TYPE:
735
ADDRESS:707 MORNING SUN CTTELEPHONE:
(707) 449-3935
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 4DATE:
06/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Administrator, Stephanie HenryTIME COMPLETED:
02:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At approximately 11:45AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct an Annual inspection visit and was greeted by Staff Member, Renee Dillard. The inspection is focused on the Infection Control procedures and practices of this facility. The Administrator, Stephanie Henry, arrived later during visit.

Upon arrival at the facility, LPA had their temperature checked and logged. LPA conducted a walk-through of the facility and observed the following: Handwashing signs were observed in the bathrooms and at sinks. COVID-19 signs were posted throughout the facility. Observed staff were wearing masks. The facility was found to be clean and at a comfortable temperature with all exits free from obstruction.

All staff have received training on Infection Control. LPA and Administrator discussed N95-Fit Testing. Facility has a cleaning and disinfecting schedule that occurs three times a day. Facility has at least a 30-day supply of Personal Protective Equipment (PPE) and medication for clients. Staff are screened daily for COVID-19 symptoms and it is logged into facility binders. LPA and Administrator discussed continuing to screen Clients for COVID-19 symptoms.

Fire Extinguisher was last serviced January 2022. Per Administrator, Fire Department inspected facility this week and checked all combination fire alarms and carbon monoxide detectors. Fire alarms and carbon monoxide detectors were tested and operational.

Continued on LIC 809C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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
Document Has Been Signed on 06/28/2022 02:14 PM - It Cannot Be Edited


Created By: Caitlynn Felias On 06/28/2022 at 01:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PEOPLE'S CARE MORNING SUN
FACILITY NUMBER: 486803540

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(b)
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on review of incident report, the licensee did not comply with the section cited above in where 1 of 4 clients did not recieve their medication as prescribed. This poses an immediate health, safety or personal rights risk to clients in care.
POC Due Date: 06/29/2022
Plan of Correction
1
2
3
4
Licensee to submit proof of training for Staff 1 (S1) by POC due date, Wednesday, 6/29/2022.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Kimberley Mota
LICENSING EVALUATOR NAME:Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022


LIC809 (FAS) - (06/04)
Page: 2 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PEOPLE'S CARE MORNING SUN
FACILITY NUMBER: 486803540
VISIT DATE: 06/28/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC809

LPA also following up with facility regarding a medication error received by Community Care Licensing (CCL) on 4/27/2022. Per incident report, Staff Member (S1) notified Management that they did not administer Resident 1's (R1) afternoon medication. Facility observed R1 and they did not exhibit any side effects from missed dose. Per conversation with Administrator, Facility will be undergoing new medication training to help decrease errors.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC-809D discussed and provided to Administrator. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3