Davis Guest Home #3

Type of visit: Required - 1 Year

Licensing Program Analyst, Noel Wolf Petersen arrived unannounced to the facility 10:45am to conduct annual inspection. LPA met with Administrator Heather McClosky and explained the purpose of the visit. Davis Guest Home 3 is a RCFE accepting clients with a cooccuring mental Illness ages 60+. Currently no residents have a restricted condition. Physical inspection, included but was not limited to: the kitchen, common areas, bedrooms, bathrooms, exteriors, storage areas, and emergency exit routes. The kitchen had adequate lockable storage for sharps, medication, and toxics. The food was in adequate supply for 2 days perishable, 7 days non perishable for 10 people at 3 meals 3 snacks a day. The bathrooms had hardware in good repair, water temperature was measured 105-120*F. The bedrooms have required furniture, including mattress encasements. Exteriors have some high grass that might constitute a tripping hazard soon. emergency exit route gate is a front gate in good repair, it's unlocked, swings freely, and can latch closed. Resident records, included but not limited to: the needs and services plan, recent medical assessments, and signed admission agreement and any amended consents. Resident records are complete and up to date, 1 client file had a signature by an LMFT on a 602, a more recent 602 had an appropriate medical professional on the signature line. LPA gave guidance that the 602 can be signed by a MD/DO, NP, or PA, and the 603 can be signed by a MD/DO. 1 client is planned to have an updated 602 shortly to have a temporary foley catheter removed before he returns to the facility. P+I funds are comingled, out of compliance with 87217(e), the LPA asked for the funds that are in the facility be stored seperately for each client such that there is not a single pool from which all funds are drawn. Facility should send a photo of the new storage solution by 3/17/2026. Continue c page Medication records were checked for understanding of documentation procedures, PRN and medical Destruction record were reviewed,no issues, refusal procedure was not. Staff records, included but not limited to: the recent trainings, the cpr/first aid training, and criminal record clearance for doj/fbi. All files were present and up to date. LPA gave guidance that the administrator should maintain a HIV/blood born pathagens training every 2 years. Administrator records, included but not limited to: the facilty posters(ombudsman, client rights, employee rights, and facility sketch with evacuation route), the infection control plan, the evacuation plan, liability insurance, and surety bond. The LPA gave guidance that California labor code requires employers have workers comp. 2 staff were interviewed, 3 clients were interviewed. Given the facilities record of past compliance, and a general trust that the administrator will address the storage of the clients funds, a technical violation was issued. No citations issued at this time. A copy of the report was read and left with the administrator. A digital copy, was send to the email on file.the state’s words, verbatim · CDSS document, Mar 12, 2026

Type of visit: Required - 1 Year

On 03/27/25, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to the facility regarding an annual inspection. LPA Campbell met with Administrator McClosky and explained the purpose of the visit. The facility is a single story residence licensed to serve 10 ambulatory clients over the age of 60. There are five bedrooms and two bathroom in all. Upon entry, LPA Campbell observed a well lit hallway leading to facility office. During the visit, LPA Campbell observed four clients present in the facility eating a snack, smoking outside and conducting a phone call. LPA Campbell spoke to two of the clients regarding a stray chicken that had entered the facility backyard and regarding a trip to the store. LPA Campbell toured the facility and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas to ensure there are no safety hazards for residents. Furniture and furnishings were sufficient to meet the needs of residents. The living room common area was clear of obstacles and contained a television as well as plentiful seating. The facility temperature was 73 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The backyard was toured by LPA Campbell and pathways and exits were found to be clear. A soda machine was observed in the backyard seating area as well. In the backyard two sheds were accessed and LPA Campbell observed client storage and where the facility washer and dryer are kept along with additional freezers.. LPA Campbell observed first aid supplies (containing tweezer, scissors and thermometers) and a fully-charged and up-to-date fire extinguisher that was last inspected on 08/01/2024. There was a general fire extinguisher for the facility and an ansul extinguisher for the kitchen. Carbon monoxide/smoke detectors were tested and found to be functioning correctly. LPA Campbell observed a minimum 2-day supply of perishable foods in the refrigerator and a minimum 7-day supply of nonperishable food in the cabinets and freezers. LPA Campbell observed locked cabinets for the storage of medication, knives and cleaning solutions Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted with Heather McClosky and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: Required - 1 Year

On 02/07/2024, Licensing Program Analyst (LPA) Renee Campbell arrived for an unannounced visit to conduct an annual inspection visit. LPA Campbell met with Heather McClosky, Administrator and explained the purpose of the visit. The facility is licensed for 10 ambulatory residents, 60 and over. There are eight residents currently in the facility. Another two residents are in the community. Residents were observed performing various activities throughout the facility by LPA. LPA Campbell toured and inspected the physical plant inside and outside. There are three sheds in the backyard for storage and a washer and dryer. All sheds were locked. LPA observed an outside lounge area with a soda machine, table and benches. The kitchen contained a dining room, cabinets and a locked sharps drawer. Perishable foods were observed with enough items to sustain the residents for two days. There were also enough non-perishable foods to last the residents for seven days. Bathrooms, bedrooms and common areas were toured and found to contain the required accessories for compliance. The bathroom water temperature was measured at 107 degrees Fahrenheit which is required to be not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). The thermostat was set at 72 degrees. LPA Campbell observed the facility first-aid kit contained scissors, tweezers and thermometers along with bandages and first-aid manuals. Toxins and cleaning products were kept locked in storage closets. The fire extinguisher was last inspected on August 8th, 2023. Smoke alarms and Carbon Monoxide alarms were tested successfully. Of the 10 staff, 2 staff files were reviewed. No bodies of water were present. Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Feb 7, 2024

Allegation investigated: Staff do not treat resident with dignity and respect. Facility smells of marijuana. Staff provide care and supervision while under the influence of marijuana

On 12/04/23, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to this facility at approximately 2:00 PM to present findings for a complaint investigation. LPA met with Heather McClosky, Administrator, and explained the purpose of the visit. Regarding the allegation that staff do not treat residents with dignity and respect, based on interviews with 10 residents, R1, R3, R4, R5, R9 and R10 did not report disrespect or shouting from staff. When questioned, R3 acknowledged that staff had cursed but it was not confirmed staff cursed at residents. Based on the result of this investigation, there is not a preponderance of evidence to prove the alleged violation occurred. The Department therefore finds the allegation to be UNSUBSTANTIATED. Regarding the allegation that the facility smelled of marijuana, LPA Campbell visited the facility and did not observe the smell of marijuana. Regarding the allegation that staff provide care and supervision while under the influence of marijuana, based on staff interviews with R1 (Resident #1) to R10, 8 residents and Unsubstantiated 3 staff reported that no current staff had been seen smoking marijuana on the premises and R10 reported that they smelled marijuana that came from the neighbors and not the facility. R3 explicitly stated that while there had been staff who had used marijuana in the past, there were no people on staff currently who used it. Therefore, the preponderance of evidence standard has not been met and the allegation is unsubstantiated. Although the allegations may have happened or be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Heather McClosky. No deficiencies are being cited at this time, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Dec 4, 2023 · control 27-AS-20231116123740