496890095-3-7-2023-21-AS-DALO-CPQ26P-20230307160729

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 496890095
Report Date: 03/07/2023
Date Signed: 03/07/2023 04:07:34 PM

Document Has Been Signed on 03/07/2023 04:07 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:	ALLURE SENIOR CARE		FACILITY NUMBER:	496890095
ADMINISTRATOR:	SHAUGHNESSEY, MERA		FACILITY TYPE:	740
ADDRESS:	2008 DENNIS LANE		TELEPHONE:	(707) 843-4090
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	6	CENSUS: 6	DATE:	03/07/2023
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Mera Shaughnessey-Administrator		TIME COMPLETED:	04:15 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 Analyst(LPA) Alviso conducted a Post Licensing visit, at about 1:15am on 3/7/23, and met with Administrator Mera Shaughnessey. There are six(6) residents in care. Facility has an approved Hospice Care Waiver for three(3). Facility has an approved Dementia Plan of Operation. Facility has submitted the required Infection Control Plan. Fire clearance is approved for six(6) non-ambulatory and/or bedridden residents, all rooms are cleared for bedridden use. All resident files were reviewed, and found to be complete. LPA reviewed staff files, including training. All staff have criminal record clearance as required. All staff are first aid and CPR certified. Caregivers are trained to assist residents with medication. Facility files reviewed showed facility evacuation drill and emergency drills are scheduled, to be completed, they are done every three months. Last evacuation drill and emergency drill was done end of October 2022 before doing the change of location. Administrator stated to the LPA that they have reviewed with staff, and run through the evacuation plan and emergency drills with staff, once the facility was licensed, 12/27/22.. LPA toured the facility with the Administrator Mera. The home was found to be clean and orderly. LPA observed sufficient food; LPA observed the residents being served lunch. LPA observed a sufficient supply of hygiene products, cleaners/disinfectants, and paper products. Continued on LIC809C...

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ALLURE SENIOR CARE	FACILITY NUMBER: 496890095
	VISIT DATE: 03/07/2023

NARRATIVE

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The fire extinguishers, two(2), are serviced and tagged as required expires 12/5/23. All exits were clear from obstruction. Smoke alarms (9) are hard wired, and are also carbon monoxide detectors.

Facility has emergency supplies, 72 hour shelter in place supplies .Facility medications are locked and inaccessible to residents in care. All toxins are locked and inaccessible to residents in care. All bathrooms have grab bars, non-slip flooring and/or mats for resident use as needed. There was sufficient lighting in resident rooms, bathrooms and hallways.

The LPA observed the home to be at a comfortable temperature upon entry into the home, and when touring the facility during the visit. There are two heater controls, one in the kitchen and one in the hallway. All utilities were on and working appropriately. All appliances were working appropriately.

Facility had a sufficient supply of personal protective equipment(PPE) for staff use as needed. Per Administrator, all staff have been in-serviced on the infection control plan, emergency drills, and evacuation plan.

No deficiencies cited today.
Exit interview conducted.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC809 (FAS) - (06/04)

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