Gaither's Family Home #3

Type of visit: POC

On 07/31/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a POC visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. House Manager, Nancy Thompson contacted Administrator via telephone. LPA received verbal permission to meet with the House Manager. The purpose of today's visit is to clear a deficiency that was issued during the annual inspection. No deficiencies issued. Exit interview conducted and a copy of this report was discussed and provided to House Manager, Nancy Thompson whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Jul 31, 2023

Type of visit: Case Management - Annual Continuation

On 07/14/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual continuation inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Qualified Intellectual Disability Professional, Anna McDonald and Facility Staff, Norma Espinoza. During today's inspection, LPA reviewed staff files. No deficiencies issued. LPA received verbal permission to complete the inspection with, Facility Staff, Norma Espinoza. Exit interview conducted. A copy of this report was discussed and provided to Facility Staff, Norma Espinoza, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Jul 14, 2023

The state marks this report as 5 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

On 06/01/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. There are 6 residents present during today's inspection. LPA met with Qualified Intellectual Disability Professional, Nancy McDonald (QIDP). LPA reviewed resident records. Medications reviewed and observed to have original labels and be administered as prescribed. First Aid Kit observed. LPA will return at a later date to review staff records. LPA conducted a tour inside and outside of facility. Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. LPA observed 3 out of 6 beds to be equipped with full bed rails. LPA confirmed with QIDP that the facility does not have an exception in place for the bed rails. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. Hot water measured at 111.1 degrees F. Kitchen toured, appeared clean and safe for food preparation. LPA observed a 7-day supply of non-perishable and 2-day supply of perishable food. Exterior tour conducted, all exits open and free of obstructions. Side gates was observed to be self-latching. Fire extinguisher serviced on 03/13/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted on 05/31/2023. All cleaning supplies are locked and inaccessible to residents in care. CONTINUED TO 809C A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted and a plan of correction was reviewed and developed with QIDP. A copy of this report and appeal rights were discussed and provided to QIDP, Anna McDonald, whose signature on this form confirms receipt of this document. LPA is requesting the following documents be submitted to the Fresno CCL office by 06/15/2023: · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.the state’s words, verbatim · CDSS document, Jun 1, 2023

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lady Cabrera arrived unannounced for an Annual Required Inspection. Administrator Anna McDonald was unavailable and directed House Manager Nancy Thompson to give the tour and sign this report. LPA stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trashcans with lid. Hand washing posters were observed by the bathrooms and kitchen sink. Bedrooms were checked. The exterior tour was conducted. LPA checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. LPA followed up on a incident report that occurred on 04/03/2022 regarding Client (C1). LPA interviewed House Manager and obtained documentation. Based on today’s inspection, deficiencies were cited in the areas evaluated and listed on the LIC809D. Exit interview was conducted. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 06/07/2022 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.the state’s words, verbatim · CDSS document, May 31, 2022

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.

Allegation investigated: RSO who is not a client allegedly resides, is present or has contact that may pose a risk to the health and safety of clients in care

Licensing Program Analyst (LPAs) Kamaldeep Kaur and Lady Cabrera conducted a complaint visit. Administrator Anna McDonald was unavailable and directed Staff Adriene Smith to sign this report. 10-day visit – Allegation: RSO who is not a client allegedly resides or has presence/contact that may pose a risk to the health and safety of the client(s) in care. This agency has investigated the complaint alleging an RSO is residing at the facility or has presence/contact that may pose a risk to the health and safety of the client(s) in care at a facility licensed by the Department. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Dec 29, 2021 · control 24-AS-20211221155904

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.