Amber Autumn Board & Care

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. LPA met with Licensee /administrator Tracy Martin, who assisted with the visit. The facility is licensed to serve elderly, ages 60 years old and older and has two (2) approved hospice waivers. The facility capacity is five (5) including three (3) ambulatory, two (2) non- ambulatory and zero (0) bedridden. The facility has dementia program in place. Annual fees are current. Administrator certificate is current with expiration date on 6/26/2026. No residents were interviewed as resident census is zero (0). During the visit, LPA conducted staff interviews, used CARE inspection tools, toured the facility, reviewed food supply, and reviewed staff records. Since the facility has not admitted resident, thus, resident interview, resident record review and medication were not conducted. The facility is a two-story house with four (4) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living room, kitchen, dining room, family room, backyard with patio, activity area in the garage, and laundry room. The residents’ bedrooms are spacious and will easily accommodate with the residents’ furnishings. Exits are installed with alarm auditory devices. Medication will be centrally stored in a locked medication cabinet and inaccessible to residents in care. All rooms are furnished with appropriate furniture for residents’ comfort. Bathrooms are furnished with grab bars and nonskid surfaces. Common areas and outdoor areas are observed for the ability to safely serve the needs of the residents. Hot water temperature is measured between 105-120 degrees Fahrenheit. Sufficient of linen supplies and personal hygiene supplies were observed. Sufficient supply of perishable and non-perishable foods was observed. Refrigerators, freezers, microwaves, ovens and counter tops observed to be clean. Plates, cups, glasses and utensils are sufficient for the current census. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged. All mandated documents and signages are posted in common areas. No deficiency was observed, an exit interview was conducted and provided to Licensee Tacy Martin.the state’s words, verbatim · CDSS document, Nov 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met Tracy Martin, Licensee/administrator and the purpose of today's visit was discussed. The facility was licensed to serve elderly, ages 60 years old and older and had two (2) approved hospice waiver. The facility capacity was five (5) including three (3) ambulatory, two (2) non- ambulatory and zero (0) bedridden. The facility had dementia program in place. Annual fees are current. For today’s visit, CARE tool was used, administrator was interviewed, physical plant was conducted, and food supply/facility files were reviewed. No resident was interviewed as resident census was 0. The facility is a two-story house with four (4) resident bedrooms, one (1) staff bedroom, four (4) bathrooms, living room, kitchen, dining room, family room, backyard with patio, activity area in the garage, and laundry room. The resident bedrooms were accommodated with the resident’s furnishings and in compliance. Bathrooms are furnished with grab bars and nonskid surfaces. Common areas and outdoor areas are observed for the ability to safely serve the needs of the residents. Hot water temperature was 114.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Exits’ auditory devices were operable. Medication box was centrally stored in a locked medication cabinet and inaccessible to residents. Sufficient of linen supplies and personal hygiene supplies were observed. Sufficient supply of perishable and non-perishable foods was observed. Kitchen appliances were observed to be cleaned. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged. No deficiency was cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to Licensee Tracy.the state’s words, verbatim · CDSS document, Oct 26, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Licensee Tracy, who assisted with the visit. The facility is licensed to serve elderly, ages 60 years old and older and has two (2) approved hospice waiver. The facility capacity is five (5) including three (3) ambulatory, two (2) non- ambulatory and zero (0) bedridden. The facility has dementia program in place. Annual fees are current. Administrator certificate is current with expiration date on 6/12/24. LPA discussed the purpose of today's visit with Licensee / administrator, Tracy. During the visit, LPA conducted staff interview, used CARE inspection tool, toured the facility, reviewed food supply, and reviewed staff records. Since the facility has not admitted resident, thus, resident interview, resident record review and medication were not conducted. The facility is a two-story house with four (4) resident bedrooms, one (1) staff bedroom, four (4) bathrooms, living room, kitchen, dining room, family room, backyard with patio, activity area in the garage, and laundry room. The resident bedrooms are spacious and will easily accommodate with the resident’s furnishings. Exits are installed with alarm auditory devices. (-continued in LIC 809 C-) Medication will be centrally stored in a locked medication cabinet and inaccessible to residents in care. All rooms are furnished with appropriate furniture for residents’ comfort. Bathrooms are furnished with grab bars and nonskid surfaces. Common areas and outdoor areas are observed for the ability to safely serve the needs of the residents. Hot water temperature is 118.2 degrees Fahrenheit which was within Title 22 Regulation guidelines. Sufficient of linen supplies and personal hygiene supplies were observed. Sufficient supply of perishable and non-perishable foods was observed. Refrigerators, freezers, microwaves, ovens and counter tops observed to be clean. Plates, cups, glasses and utensils are sufficient for the current census. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged. All mandated documents and signages are posted in common areas. No deficiency was cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to Licensee Tracy, whose signature on this form confirm receipt of these documents.the state’s words, verbatim · CDSS document, Dec 19, 2023