Bob & Corky's Care Home VI

Type of visit: Required - 1 Year

At 8:45am, on February 11th, 2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator Shawna Harney, announced who he was and the reason for the visit. Administrator and LPA conducted a full tour of the facility. This facility is a single story residential home with five resident bedrooms (one is dual occupancy) and four full bathrooms (three are on-suite to resident rooms and one is for shared/public use). There is a living room with dining space and a kitchen. The living room has a self contained fireplace. Access to the laundry area/garage is through locked doors for resident safety. LPA noted that the backyard and the front yard both have seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen for residents to enjoy freely. The facility has wired dual smoke and carbon monoxide detectors in each bedroom and hallway leading to bedrooms that are all working. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 3/21/2025. LPA tested facility hot water at 105.8*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean and in good repair with no obstructions in hallways, doorways or exits. Medications are locked in a cabinet. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review. LPA and Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview conducted, report signed, and report provided the Administrator.the state’s words, verbatim · CDSS document, Feb 11, 2026

The state marks this report as 15 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At 8:35am on 03/19/2025, Licensing Program Analyst (LPA) Haner-Tomasko, arrived unannounced at the facility to conduct the annual facility inspection. LPA met with Administrator Shawna Harney, announced who he was, and the reason for the visit. Administrator and LPA conducted a full tour of the facility. The facility is a 5-bedroom 4-bathroom house, with a living room, kitchen, and dining area. There is one dual occupancy bedroom. Three of the bedrooms have on-suite bathrooms and there is one public full restroom. All bathrooms have walk-in showers. The garage is locked and this is where the chemicals, laundry, and medications are kept. There is a patio located at the front of the facility and a fenced backyard, both with chairs and umbrellas for residents and visitors to safely enjoy shaded outdoor space. LPA noted that the bathrooms are clean. Hand soap and paper towels available in each one. LPA observed a full first aid kit available. LPA noted fire extinguisher in the kitchen serviced on 4/4/2024. LPA noted smoke alarms/carbon monoxide detectors located in each room throughout the facility; all of these devices were tested and are functioning. LPA observed at least two days of perishable foods and more than seven days of non-perishable foods on hand at this facility. At 09:00am facility lost power due to a local PG&E power outage. Staff remained attentive to residents, regularly checking on them. Call system continued to function on battery backup. Gas stove was functioning to prepare food. LPA noted prior to outage the facility telephone was operational, all staff have mobile phones as backup. Facility located rental generator if outage becomes extended. LPA noted that all doors and exits were free of obstructions. LPA reviewed centrally stored medications, staff files and resident files. Infection control and emergency/disaster plans reviewed. LPA and administrator conducted review of care modules. Exit interview, report signed, and report provided.the state’s words, verbatim · CDSS document, Mar 19, 2025

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 9:45 am to conduct a 1-year annual visit to the facility above. LPA met with Administrator, Shawna Harney and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs are visible in the guest bathroom. The facility has EPA approved disinfectant spray and cleaners. The facility has a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Trash cans and wastebaskets have tight fitting covers. Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on April 7, 2023. The facility has 5 resident bedrooms, and 3 bathrooms. LPA was authorized to enter and inspect facility. The facility has a smoke and carbon monoxide detector that was tested and was working properly during visit. Continued 809-C The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectants, cleaning solutions and poisons are inaccessible to residents in care and are locked in garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a secured backyard and front patio for client use with plenty of shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on April 19, 2024. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-Ambulatory, 1 of which may be bedridden in room 5 only. Hospice is approved for 4. Staffing: The facility currently employes 7 full time staff, and 3 Administrators. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance and education requirements. Administrator Certificate expires November 21, 2024. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2023 and 2024. (Continued 809-C) Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Safeguard for property and valuables, LIC. 602A Physicians report, Appraisals Needs and Services Plan, Emergency and ID forms. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and plenty extra, to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides assistance in arranging transportation to medical and dental appointments when needed. Residents have on-call doctor that visits facility. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. (Continued 809-C) Residents with Special Health Needs: The facility does accept dementia residents in care. The facility currently has residents receiving Home Health services. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Mar 15, 2024