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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600632
Report Date: 08/01/2023
Date Signed: 08/02/2023 08:59:02 PM


Document Has Been Signed on 08/02/2023 08:59 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:TENDER TOUCH RESIDENTIAL CARE HOMEFACILITY NUMBER:
075600632
ADMINISTRATOR:CRUZ, ESTRELLITA S.FACILITY TYPE:
740
ADDRESS:58 MIDHILL ROADTELEPHONE:
(925) 228-5683
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:6CENSUS: 6DATE:
08/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Artemia Kaipat, CaregiverTIME COMPLETED:
04:45 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
On 08/01/2023 at 12:25 PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Plan of Correction (POC) visit. LPA met with Caregiver, Artemia Kaipat. The Licensee/Administrator, Estrellita Cruz, was not available and is still out of the country. Caregiver, Oscar Santos, says that Estrellita will return back on 08/26/23.

LPA asked Artemia which residents were on hospice care and Artemia says, "R1, R2 and R3." LPA observed R1, R2 laying in their beds in bedroom# 1. R3 was sitting down in the living room. LPA requested the Hospice Care binders from the agencies (i.e., admissions/care plan) for R1, R2 and R3 but Artemia only had the resident's regular facility files and not the hospice care plan. Artemia says that when the hospice agency visits they only sign-in on their "Visitor Registry" at the front door.

LPA reviewed and received copies of Physicians Reports (R1,R2,R3), Appraisal Needs and Services (R1 for '20, '23) and Notice of Medicare Non-Coverage from Bridge Hospice (R1).

LPA spoke with Registered Nurse, RN1, that came to visit R2 due to change in condition from his visit yesterday. Eric says that he is from Care Plus Hospice (Livermore) and that the only patients that he currently has in care is R2, R3 and R4. RN1 says that R1 "Graduated" (discharged) from hospice care on 07/28/23.

RN1 (RN) says that they (agency) only updates the families (e.g., phone call if there is a "change in condition." The patients files are updated electronically, but he will get the residents care binders delivered by tonight. Before LPA left the facility the hospice care plan binders were delivered.

LIC 809-C Continued....
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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 08/02/2023 08:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612


FACILITY NAME: TENDER TOUCH RESIDENTIAL CARE HOME
FACILITY NUMBER: 075600632

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/08/2023
Section Cited
CCR
87632(d)(2)

1
2
3
4
5
6
7
(d) If the Department grants a hospice care waiver...(2) The licensee shall notify
1
2
3
4
5
6
7
Licensee/Administrator will review the regulation and send notification for each residence on hospice to CCL by POC Due Date.
8
9
10
11
12
13
14
Based on observation and review, the licensee did not comply with the section cited above which poses an immediate health and safety rights risk to persons in care.
8
9
10
11
12
13
14
Type B
08/08/2023
Section Cited
CCR87405(a)

1
2
3
4
5
6
7
(a) All facilities...certified administrator. When the administrator is not in the facility...designated substitute ...administration of the facility as specified in this section.
1
2
3
4
5
6
7
Licensee/Administrator will review the regulation and submit updated LIC308 to CCL by POC Due Date.
8
9
10
11
12
13
14
Based on observation, review and interview the licensee did not comply with the section cited above which poses an immediate health, safety and personal rights risk to persons in care.
8
9
10
11
12
13
14
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: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: TENDER TOUCH RESIDENTIAL CARE HOME
FACILITY NUMBER: 075600632
VISIT DATE: 08/01/2023
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
LIC 809 Continued...

LPA reviewed during Annual visit on 06/23/23 that there were only 2 residents on hospice care; R1 and R5. However, Artemia, assured that R5 was not on hospice care and must have "Graduated" before she started working at the facility.

LPA observed that POCs were cleared from 06/23/23 Annual visit up to 07/19/23 except HSC 1569.618(c)(3) for S3. Civil penalties will continue to be assessed for cited deficiency.

LPA addressed to Artemia that an hospice exception is still needed for the 3rd resident on hospice care. Artemia expressed that she thought that the Licensee had already submitted all the "paperwork" for an "hospice waiver." LPA explained to Artemia that yes, there were documents received from the Licensee back on 07/21/23. However, LPAs L. Alexander and L. Fontanilla had already verbally discussed and explained that an "hospice waiver" would only be specifically considered as an exception for the 3rd hospice resident only. The "hospice waiver" has not been approved yet and is still under review. The Licensee remains to be out of compliance in terms of being over capacity.

  • LPA observed and reviewed that hospice notifications not submitted to CCL.
  • LPA observed that caregiver on site could not provide hospice care plan of residents that is on hospice care.

The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3