Community Care Licensing

Document Has Been Signed on 08/28/2023 02:39 PM - It Cannot Be Edited

FACILITY NAME:	CALIFORNIAN, THE		FACILITY NUMBER:	570316115
ADMINISTRATOR:	KATHY B. NEESER		FACILITY TYPE:	740
ADDRESS:	1224 COTTONWOOD STREET		TELEPHONE:	(530) 666-2433
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95695
CAPACITY: 130		CENSUS: 91	DATE:	08/28/2023
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Administrator, Kathy Neeser		TIME COMPLETED:	02:30 PM

SUPERVISORS NAME: Hope DeBenedetti LICENSING EVALUATOR NAME: Farhaan Sarangi LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023

Link to Parent Document Below:

FACILITY NAME: CALIFORNIAN, THE	FACILITY NUMBER: 570316115
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/11/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.	1 2 3 4 5 6 7	Plan of Correction shall include retraining ALL staff as it relates to answering call bells in a timely manner. In addition, Administrator shall provide a written summary on how future compliance will be met and an LIC 9098-Self Certification
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews and observations, LPA observed Call Bell logs from June 15, 2023 through July 3, 2023 in which residents would push the call buttons and the response times were exceeding over 30+ minutes. Furthermore, LPA interviewed 4 of 4 residents and learned that the residents corroborated the wait times for assistance which is a potential health, safety and personal rights risk to the residents in care.	8 9 10 11 12 13 14	Summary for future compliance-Plan of Correction due on August 29, 2023. All staff proof of training is due on September 11, 2023.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

SUPERVISOR'S NAME: Hope DeBenedetti LICENSING EVALUATOR NAME: Farhaan Sarangi LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023