Fairfield Meadows

Type of visit: Required - 1 Year

At approximately 1:35 pm, Licensing Program Analyst (LPA) Stevenson arrived unannounced to BEGIN a required 1-year annual inspection and was greeted by Rose Marie Vister, Designated Responsible Party (DRP). Administrator Maria Salvador was contacted via telephone and advised of the inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care, all of whom were present during today's inspection. Facility has a Dementia Care Plan, a Hospice waiver for two (2), and is approved for all non-ambulatory residents with approval for one (1) bedridden resident. At approximately 01:45 PM, LPA initiated a tour of the facility with DRP and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA continues to see evidence of on-going rodent treatment with various traps below kitchen sink and garage used as additional pantry with foods in storage devices. LPA observed large hole in the exterior wall behind garage wash machine and dryer that represent and easier access point for rodent into the garage being used as a pantry/storage. LPA observed worn carpeting with staining throughout the facility as seen in the last annual inspection performed. A drawer face to the left of the stove was loose and evidence of water intrusion into the sheet rock in the bathroom walls was evident. In addition, LPA observed two (2) rotten deck boards outside the living room sliding door that represent a tripping hazard. 4 of 8 smoke detectors either required new batteries or did not emit the proper volume of alarm and a Plan of Correction (POC) was made to address a number of the facility issues.A repeat citation 87303(a) for grounds out of repair and civil penalty is being assessed. (See LIC809-D page) Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Cabinets containing cleaning supplies and medicines and other items that could pose a risk were locked. Continued on LIC809-C continued from LIC809 LPA will return at a later date to continue the annual required inspection to further inspect facility repair and upkeep, as well as, facility, staff and resident files. LPA will request updated copies of upon completion of final inspection visit including: 1)Updated Liability insurance 2)Updated LIC500 Personnel Report 3)Updated LIC9020 Register of Facility Residents. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Rose Marie Vister (DRP) and Appeal rights were given.the state’s words, verbatim · CDSS document, Dec 30, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

At approximately 9:45 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a case management -- annual continuation visit to issue citations for deficiencies observed during initial annual inspection visit on 2/14/2025 (see LIC809Ds) and met with RoseMarie Vister, Designated Responsible Party (DRP), and Christian Salvador, Designated Responsible Party who left at approximately 1:00 PM. Prior to leaving today, Christian explained to LPA that the facility was awarded a grant from the county to complete facility renovations since the facility houses and cares for residents who are a part of a county program that qualified the facility for this grant. The facility is currently awaiting word from the county on when renovations will begin as the county is coordinating the entire project. Additionally, Christian informed LPA that facility intends to apply for a new license to change from a Residential Care Facility for the Elderly (RCFE) to an Adult Residential Facility (ARF). LPA provided Centralized Application Bureau information for facility to begin this process. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12 month period, may result in a civil penalty assessment. Exit interview conducted with DRP, whose signature on form confirms receipt of documents. Appeal rights provided.the state’s words, verbatim · CDSS document, Mar 14, 2025

The state marks this report as 16 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 12:00pm, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by RoseMarie Vister, Designated Responsible Party (DRP). House Manager, Christiane Salvador was contacted via telephone and arrived at facility at approximately 1:30pm. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care, all of whom were present during today's inspection. Facility has a Dementia Care Plan, a Hospice waiver for two (2), and is approved for all non-ambulatory residents with approval for one (1) bedridden resident. At approximately 12:30 PM, LPA initiated a tour of the facility with DRP and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA observed egress devices deactivated on all facility doors while two (2) dementia residents were in care. DRP activated them immediately. Additionally, rodent bait was observed in the facility entryway coat closet. House Manager states that with recent construction nearby, the facility has experienced an influx of rodent issues. Further, House Manager states that pest control have been out to the facility three times since mid-December and are scheduled to come treat the facility again soon. LPA observed worn carpeting with staining throughout the facility. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. However, LPA observed shower towels, face rags, and washcloths in client bathroom. DRP removed them immediately and agreed to ensure the facility is in compliance with regulation moving forward. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. However, two (2) of six (6) residents did not have their own designated chest of drawers for clothing storage. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Continued on LIC809-C... Continued from LIC809C... LPA observed sharps such as two pairs of scissors and a kitchen knife not secured in the kitchen. Additionally, LPA observed a lock installed on both the refrigerator and freezer in the facility kitchen. DRP removed the locks immediately and agreed to ensure the facility operated in compliance moving forward. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. LPA observed uncovered meat and food in the refrigerator and freezer, as well as food that was not dated or labeled after opening or repackaging. LPA also observed two unlocked plastic storage bins with diabetic residents' insulin in the facility refrigerator. All remaining medications were observed centrally stored and locked. There is a shaded seating area in the front and backyards with outdoor space for activities. LPA observed damage to the living room ceiling consisting of two holes larger than a dollar bill and an approximately 3 foot by 12 foot section of Sheetrock damaged in the garage. House manager states that the facility was approved for a County grant for renovations and improvements to board and care facilities and the facility plans to fix these areas of concern as well as replace the flooring throughout the facility, redo the bathrooms and kitchen, and paint throughout. LPA also observed an unlocked storage shed with chemicals inside. Residents were observed laying around for the duration of today's inspection except when performing personal hygiene or eating dinner. LPA did not observe any further activities taking place during today's inspection. Facility has internet service available to residents in care and the telephone was tested an operational during inspection. Facility's fire extinguisher was observed charged and was last serviced 03/2024. Smoke and Carbon Monoxide detectors were tested during inspection, one (1) of which was observed missing, and four (4) others where inoperable. The remaining smoke and carbon monoxide detectors were operational during today's inspection. Facility conducts bi-annual disaster drills, and the most recent drill was conducted 11/2024. LPA informed DRP and House Manager that drill shall be conducted on a quarterly basis moving forward, and both agreed to bring the facility into compliance. LPA observed the facility's infection control plan, and facility has a first aid kit, PPE, and emergency supplies for emergency preparedness. LPA reviewed facility's emergency disaster plan which was last updated in 2003. Continued on LIC809C... Continued from LIC809C... At approximately 2:00pm, LPA conducted file review. Facility has four (4) staff and all four staff files were reviewed. Three (3) staff files reviewed were missing proof of some or all of their training hours, two (2) staff files were observed missing proof of negative TB results, and the administrator did not have a copy of their current certificate posted or present in the facility. DRP and House Manager were unable to provide LPA with a LIC500 Staff Roster (schedule) showing who works when and how many hours per week. Two care staff live in the facility. LPA informed House Manager that the Administrator shall be present in the facility a sufficient number of hours to ensure the facility operates in compliance per regulation. All staff have proof of current First Aid and CPR certification. LPA reviewed six (6) of six (6) resident files which were each observed missing at least one (1) of the required documents. Four (4) of six (6) residents in care are under the age of 59 and the facility does not have an exception or waiver for this. House Manager states that the demographic has changed over the years and the facility may want to apply for an Adult Resident Facility (ARF) License rather than remaining a Residential Care Facility for the Elderly (RCFE). House Manager states that the residents' family members or county case managers coordinate residents' medical and dental appointments and transportation to and from visits. However, facility staff are available to assist with transportation to these appointments as needed. Medications and medication records were inspected and the logs were observed to not be maintained in compliance with regulation, and LPA observed medications pre-poured five days ahead. Facility does not handle P&I. LPA will return at a later date to complete this annual inspection and will issue citations and possible civil penalties at that time. No deficiencies cited during today's inspection. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC500 - Personnel Report (updated) Proof of Liability Insurance (Updated) LIC308 - Designation of Facility Responsibility LIC610D - Emergency Disaster Plan (updated) Current Administrator Certificate Exit interview conducted with DRP whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Feb 14, 2025

The state marks this report as 19 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff member pushed the resident agressively

At approximately 10;00am, Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to deliver findings regarding the above allegation and met with Chet Salvador, Administrator. Complaint alleges staff member pushed the resident aggressively. Per interviews conducted, resident revealed to Reporting Party that the staff at Fairfield Meadows pushed and bullied a client. During the most recent incident, staff yelled and pushed noted resident, resulting in resident hitting the wall. Per interviews conducted, outside parties and witnesses have never observed the staff being aggressive with residents or yelling at residents. Per LPA’s interview with noted resident, staff is aggressive with them, sometimes hitting them. Per LPA’s interview with witness, it has been reported that staff has been aggressive with a resident. However, staff being aggressive has not been directly observed. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.Nothe state’s words, verbatim · CDSS document, Jan 30, 2024 · control 21-AS-20231214092330

Type of visit: Case Management - Other

At approximately 10;00am, Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a case management and met with Chet Salvador, Administrator. In the course of investigating LPA learned facility does not currently offer or provide access to any activities. However, per facility's Plan of Operation, activities are offered per their activity program: cognitive and physical activities such as games and exercise that develop and maintain strength, coordination, and range of motion are supposed to be available. Per Admin, there currently are not any activities available for the residents that would facilitate cognitive and physical activities as stated in their Plan of Operation. Per Title 22 regulation 87219 Planned Activities (i) Facilities shall provide sufficient equipment and supplies to meet the requirements of the activity program including access to daily newspapers, current magazines and a variety of reading materials. Special equipment and supplies necessary to accommodate physically handicapped persons or other persons with special needs shall be provided as appropriate (deficiency cited, see 809D). Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Jan 30, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(i) · Plan of correction due date: Feb 5, 2024

87219(i) Facilities shall provide sufficient equipment and supplies to meet the requirements of the activity program... necessary to accommodate physically handicapped persons... This requirement was not met as evidenced by: Based on LPA observation and Admin confirmation facility does not currently offer or provide access to any activities, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 30, 2024

Plan of correction: Admin to purchase a variety of cognitive games and offer activities that encourage physical activity. Admin will submit LIC9098 self-certifing appropriate activities now available along with pictures of purchases and residents engaging in activities by plan of correction due date of 2/5/2024.

Type of visit: Required - 1 Year

01/23/2024 10:15 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with care staff Rosemarie Vister and explained the purpose of the visit. Administrator Maria Salvador was unavailable for the visit and gave permission for LPA to conduct the visit with staff. LPA Knight and staff toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to four (4) resident rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. All employees requiring background checks are cleared. The facility has a hospice waiver for 2 residents. Bedding, linens, and towels for residents were observed and found to be clean and in good repair. There is an adequate supply of toiletries for the residents. Medication is locked in a cabinet. The facility was observed to be at a comfortable temperature. HCommon area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean, in good repair and contained necessary grab bars and non-slip floors. Kitchen was clean and in good repair. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Fire extinguishers fully charged and were inspected by the fire marshall. Smoke detectors are all operational. No pools/bodies of water are on premises. No firearms are on premises. LPA requested the following documents to be sent to CCL Santa Rosa office: LIC 500- Personnel Report Most up-to-date Liability insurance In the areas toured no immediate health, safety, or personal rights violations were observed. No deficiencies are being cited as a result of today’s inspection. Technical assistance was provided. Exit interview conducted and copy of report was provided to Rosemarie Vister.the state’s words, verbatim · CDSS document, Jan 23, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.