C&F Senior Care Home American Canyon

Type of visit: Required - 1 Year

At approximately 11:50 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Caregiver. Administrator Lina Fojas was called and arrived at approximately 12:05 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. Facility has a Hospice waiver for four (4), with one (1) Hospice resident currently in care, and is approved for all non-ambulatory residents. At approximately 12:10 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a two (2) story home, was a comfortable temperature, and passageways were free from obstructions. Facility second story is for staff use only and has been made inaccessible to residents. Fire extinguishers were last inspected 7/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 110.3 degrees F and 112.6 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed one (1) locked shed in the backyard which LPA inspected and observed the contents to consist of bicycles, items for outdoor activities, and gardening supplies. Continued LIC809C... Continued from LIC809... Facility has an internet access device and internet available to clients in care, and the phone was tested and operational during today's inspection. Facility conducts quarterly disaster drills, and the most recent drill was conducted 6/25. LPA observed facility's infection control plan and emergency disaster plan. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 12:40 PM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 1:10 PM LPA conducted review of four (4) staff records. All required documentation present. At approximately 1:40 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Lina Fojas Administrator Certificate 7001660740 expires 10/5/2025. All fees are current as of this time. Updated copies of the following documents were gathered during this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Sep 2, 2025

The state marks this report as 4 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

At approximately 10:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Lina Fojas and explained the purpose of the visit. Administrator certificate is current. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. First Aid/CPR certification was current. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required seven-day non-perishable and two day perishable supply of food. Medication is locked and not accessible. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. Facility has fire sprinklers throughout. All employees requiring background checks are cleared. Staff annual training was current. No pools/bodies of water are on the premises. Facility has been conducting drills every 3 months. Exit interview conducted and copy of report was provided to administrator. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Current Lease Agreement LIC500- Personnel Report No deficiencies were observed in the areas inspected, No citations were issued during today’s visitthe state’s words, verbatim · CDSS document, Aug 28, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator, Lina Fojas. There are currently 4 residents in care. This facility is licensed for 5 non ambulatory residents, with hospice waiver approved for 4 of the residents and none of the residents are approved for bedridden. LPA toured the home and found the home organized at a comfortable temperature with all exits free from obstruction. This home is a two level home and all the resident bedrooms are located on the first level of the home. Residents have a call button to alert staff for assistance. Exit doors have auditory alarms to alert staff. Smoke detectors and carbon monoxide detectors were tested and operational. The fire extinguisher located in the kitchen was observed charged and facility had a proof of purchase receipt attached of 6/19/2023. Fire drills are conducted and the last one was documented on 8/6/2023. Water temperature in the resident bathroom was tested and found to be within appropriate range of 105-120 degrees. Bathrooms have required non-skid surfaces and grab bars. Cleaning products and knives are stored in locked cabinets in the kitchen. There was a 7 day supply of non-perishable foods. There are adequate dishes, glasses and silverware. Residents' medications are stored in kitchen locked cabinet. Resident and staff files are located and locked in cabinet. LPA reviewed staff files and staff did not have proof of the required 8 hours of Dementia training. Staff had proof of 1st aid but did not have proof of at least 1 staff having CPR at all times. LPA also found staff S1 who was previously associated to this facility, was no longer associated, as the administrator sent in a request to Community Care Licensing (CCL) to remove S1 and S1 was removed by CCL on 8/7/2023. Administrator rehired S1 but failed to request a fingerprint association to associate S1 to this facility prior to working. Resident files were reviewed and found in compliance. Continue report see LIC809-C LPA discussed Emergency Disaster Plan and Infection Control Plan. During todays visit, LPA requested facility to add lamps to all resident bedrooms. Licensee/Administrator to submit the current following documents by 11/10/2023: · LIC 308 Designation of Facility Responsibility (Received 10/13/2023) · LIC 500 Personnel Report- (Received 10/13/2023) · LIC 400 Affidavit Regarding Client/Resident Cash Resources(Received 10/13/2023) · LIC 610E Emergency Disaster Plan(Received 10/13/2023) · LIC 9020 Register of Facility Residents(Received 10/13/2023) Infection Control Plan of Operation (If changes) Copy of Liability Insurance- (Received 10/13/2023) Copy of Administrator Certificate See report LIC809-D for Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights provided. Exit interview conducted with Lina Fojas.the state’s words, verbatim · CDSS document, Oct 13, 2023