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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507002685
Report Date: 09/10/2021
Date Signed: 09/13/2021 08:21:39 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ST. FRANCIS ASSISTED CAREFACILITY NUMBER:
507002685
ADMINISTRATOR:JAMI YOUNGFACILITY TYPE:
740
ADDRESS:120 TWENTIETH CENTURY BLVDTELEPHONE:
(209) 668-8014
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:56CENSUS: DATE:
09/10/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
02:00 AM
MET WITH:Administrator Jami YoungTIME COMPLETED:
03:30 PM
NARRATIVE
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On 9/10/2021 Licensing Program Analyst (LPA) Sarah Hurt, arrived announced to conduct a Case Management - Health and Safety visit based on a report of COVID-19 outbreak. LPA met with Administrator and explained the reason for the visit.

As of today 18 residents tested positive and 7 staff tested positive of which 7 staff have cleared and returned to work. Currently all residents are under isolation order due to the outbreak. The LPA discussed infection control measures and mitigation of COVID-19 in the facility including but not limited to screening, isolation, disinfection, and use of personal protective equipment (PPE). The facility reported that they were not conducting weekly testing of non-vaccinated staff. The facility is not following Mitigation Plan and infection control practices to mitigate the spread of COVID in the facility.

LPA interviewed staff and found that no facility staff have been fit tested for N95 respirator nor is there record of staff training for donning and doffing. LPA observed, residents have not been separated from positives and non-positives, staff have not been designated to only work with COVID positive or negative residents, facility is not following mitigation plan facility does not have a sufficient supply of PPE.


Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. Exit interview held with Administrator who was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights.



SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ST. FRANCIS ASSISTED CARE
FACILITY NUMBER: 507002685
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2021
Section Cited

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87468.1(a)(2) Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.


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This requirement is not met as evidence by:
Based on observation and interviews the licensee did not ensure residents were accorded safe and healthful accommodation due to staff not conducting proper screening of individuals before entering facility and not wearing masks at all time, not conducting weekly surveillance testing of staff, which poses an immediate health and safety risk to residents in care
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Type A
09/11/2021
Section Cited

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87205(a) Accountability of Licensee Governing Body
(a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves.

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This requirement is not met as evidence by:
Based on observation and interview the licensee has not exercised general supervision over the affairs of the facility. The department called and left multiple messages for the licensee without any response back which poses an immediate 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: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2021
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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ST. FRANCIS ASSISTED CARE
FACILITY NUMBER: 507002685
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/10/2021
Section Cited

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87465(a)(3) Incidental Medical and Dental Care
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (3) There shall be arrangements for separation and care of residents whose illness requires separation from others.
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This requirement is not met as evidence by:
Based on observation and interview the implemented a plan to make arrangements for separation and care of residents whose illness requires separation from others. The facility does not have a plan to separate COVID positive residents from non-non positive residents, which poses an immediate health and safety risk to residents in care.
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Type A
09/11/2021
Section Cited

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87405(d)(2) Administrator - Qualifications and Duties
The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations.
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This requirement is not met as evidence by:
Cal OSHA laws required all staff required to where an N95 mask be fit tested. Based on interview the administrator has not ensured all staff are fit tested for use of N95 respirators, which poses an immediate 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: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2021
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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ST. FRANCIS ASSISTED CARE
FACILITY NUMBER: 507002685
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2021
Section Cited

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HSC 1569.58(a)(2) Employee Actions: Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California.
This requirement is not met as evidence by:
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Based on observation and interview the licensee did not protect the personal rights of clients in care to receive safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of clients in care, in that the facility has not following infection control practices which poses an immediate health and safety risk to residents in care.
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Type A
09/13/2021
Section Cited

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87411(c)(B) Personnel Requirements – General
All RCFE staff who assist residents with personal activities of daily living shall receive at least ten hours of initial training within the first four weeks of employment and at least four hours annually thereafter.
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 (3)The training shall include, but not be limited to, the following: (B)Importance and techniques of personal care services, including but not limited to, bathing, grooming, dressing, feeding, toileting, and universal precautions. At least three (3) of the required ten (10) hours shall cover this subject.This requirement is not met as evidence by:
Based on observation and interview the licensee did not ensure that staff received proper training in universal precautions including proper donning and doffing of PPE which poses an immediate 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: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4