486803710-12-17-2021-21-AS-VWIS-C9SSHJ-20211217125338

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 486803710
Report Date: 12/17/2021
Date Signed: 12/17/2021 12:55:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	PARAMOUNT HOUSE SENIOR LIVING		FACILITY NUMBER:	486803710
ADMINISTRATOR:	REMIGIO, RICHARD		FACILITY TYPE:	740
ADDRESS:	2061 PEABODY RD		TELEPHONE:	(707) 455-0300
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	95	CENSUS: 80	DATE:	12/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Richard Remigio		TIME COMPLETED:	01:03 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	Licensing Program Analysts (LPA) Victoria Willis and Caitlynn Felias arrived unannounced, to conduct an Annual Required inspection and met with Administrator, Richard Remigio. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival, LPAs observed that the facility has some Covid-19 posters on the front door. Once inside, LPAs observed an electronic thermometer on the wall and an area to sign in and answer a questionnaire with standard Covid-19 symptoms and the visitor's vaccination status. Receptionist was unavailable upon arrival. LPAs discussed the importance of having an individual available to screen visitors which includes conducting vaccine verification per Provider Information Notice (PIN) 21-40-ASC. LPAs conducted a walk-through of the facility which included Assisted Living and Memory Care and observed hand washing signs in public restrooms and hand sanitizer stations at the entrance to the dining room and memory care unit. LPAs suggested additional hand sanitizer stations throughout the facility to promote hand sanitization. Administrator provided documentation showing that staff are screened at the beginning of their shift. Per conversation with Administrator, residents are screened midday by a Medication Technician but was unable to find temperature documentation more recent than 6/2021. Staff who maintains documentation was not available but Administrator will follow up to ensure that residents are being screened daily. Facility was a comfortable temperature and exits were free from obstructions. Per Administrator, they regularly discuss infection control with residents and staff. Residents are encouraged to wear masks when outside of their rooms and staff are required to wear them while in the facility. Observed staff had masks on during this visit. Commonly touched surfaces are disinfected at least once per day, and after use. LPAs confirmed that facility is following the staff vaccination guidance per PIN 21-44-ASC. Administrator has been requested to review PIN 21-49-ASC regarding updated guidance on communal dining, group activities, entertainment, non-essential services, and transportation. Continued on LIC809C

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: PARAMOUNT HOUSE SENIOR LIVING	FACILITY NUMBER: 486803710
	VISIT DATE: 12/17/2021

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Continued from LIC809

Facility has a designated visitation area outside and is allowing for inside visitation after vaccination verification or proof of a negative test within 72 hours, per current CCL guidance. Visitors are required to wear a mask while in the facility. Facility has submitted their Covid Mitigation Plan and it has been reviewed by CCL. Facility has at least a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, face shields, gowns and hand sanitizer. PPE is located in multiple areas of the facility. LPAs suggested that PPE is centralized so it is more easily accessible to staff. Facility maintains a 30 day supply of medication. Caregivers have completed PPE training but have not been N-95 Fit tested.

Administrator and LPAs discussed their Emergency Disaster Plan

No deficiencies cited during this inspection.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

LIC809 (FAS) - (06/04)

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