Fort Faith RCFE

Type of visit: Required - 1 Year

On 08/11/2026 at 08:06am, Licensing Program Analyst (LPA) Zina Brown arrived at the facility to conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the 1 year inspection. LPA met with Nisha Fort (Administrator) and the purpose of the visit was discussed. Facility is licensed age 60 and over and is approved for 4 ambulatory. None of the residents are diagnosed with dementia nor receiving home health, hospice care or palliative care services. The facility does not handle any of the residents’ money. The facility has liability insurance with Primary Care Insurance, a Risk Retention Group, Inc (NAIC #16959) ; policy # PCI71568676-02 which is valid from 05/17/2026 - 05/17/2027. The facility has a surety bond (Bond #496441D) with a bond amount of $3000 effective as of 08/11/2026 - 08/11/2027 ; Agent: Brooklyn Ventures Suretybonds.com Insurance Agency LLC. The annual fee are a balance of $0 ; paid in full. The facility holds a Administrator Certification for Nisha Fort #7032985740 which is valid from 12/02/2025 - 12/01/2027. The home is a single story home consisting of: (3) bedrooms of which 1 is currently vacant, (2) bathrooms, living room, kitchen with dining area, laundry area inside the kitchen with a washer and dryer and an outdoor shaded patio area. At 8:20am, the Department toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 118.8 in kitchen & 117.6F in bathroom Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Between the hours of 8:40am - 9:40am, the Department conducted a records review of (2) client records, (2) staff records, & (2) Medication Administration Record. The last evacuation drill was conducted on 07/10/2026. The department reviewed the facility disaster plan which is current and in compliance with Title 22 at the time of visit. LPA observed the following not in compliance: Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8) The department observed the following deficiencies: 87506(a) Resident Record (2) Personal & Incidental (P & I) Records for R1 & R2 80066(c) Personnel Records (2) First Aid/CPR for A1 and S1 (1) 20 Hours of Staff Training for S1 (2) LIC 501 Personnel Record for A1 & S1 Exit interview conducted with Nisha Fort (Administrator) and a copy of this report was provided with appeal rights.the state’s words, verbatim · CDSS document, Aug 11, 2026

Type of visit: Required - 1 Year

On 09/17/2025, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the DSP Brenda Flowers. LPA Watson explained the purpose of today’s visit and was granted entry into the facility. The facility is licensed for (4) ambulatory residents aged 60 and up. The facility consists of (3) resident bedrooms, (2) bathrooms, (1) living room, (1) dining room, and (1) kitchen. LPA Watson toured the physical plant with Brenda Flowers. There were no bodies of water or obstructions on the premises. A total of (3) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage of the resident’s personal belongings was observed. Bathrooms were found to be clean and absent of mildew and within Title 22 regulations and were operational. LPA inspected (4) smoke alarms /carbon monoxide detectors and they were in operable condition. The water temperature properly measured between: 117.5°F - 119.8°F: Kitchen 118.4°F, Bathroom #1:117.5°F and Bathroom #2:119.8°F. LPA Watson observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed. Sharp objects and cleaning agents were locked and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available on the property. The fire extinguisher was charged and operable. LPA reviewed (1) residents service file, and (3) staff personnel files were also reviewed. LPA checked (1) Medication Administration Records (MAR) and no discrepancies were found. The first AID kit was checked and contained the correct manual, scissors, tweezers, gauze, tape and bandages. The last facility disaster drill was held in July 2025. LPA observed the facility's infection control practices, postings were prominently displayed and a copy of the surety bond dated August 12th 2025 was on file. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to the DSP Brenda Flowers.the state’s words, verbatim · CDSS document, Sep 17, 2025

Type of visit: Case Management - Annual Continuation

On 07/30/2024 at 12:44 PM Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual required visit. (LPA) met with the Marcia Bailey for (2) developmentally disabled or mentally ill adults ages 59 and up. Currently the home has (2) clients.The facility is a one story structure located in a residential neighborhood and consists of the following: (3) client bedrooms, two (2) common bathrooms (1) living room area (1) dining area, (1) kitchen, an outside patio area and a front porch area. LPA Troy Watson toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser chairs and closet space was observed. Bed linens, comforters and bath towels were adequately stocked at the time of visit. The bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly.The bathtub was free of mold/mildew. There is adequate lighting, and sufficient toiletries are accessible to clients. The water temperature properly measured between 116 F and 117.2 F in the bathrooms and in the Kitchen. Evaluation Report continues LIC 809-C LPA Troy Watson observed the facility clean, sanitary, and appropriately furnished at the time of the visit. The kitchen, and refrigerator was fully stocked with food. The administrator has (4) smoke detectors/carbon monoxide detectors that have been tested and found operational. Toxins and knives were locked and inaccessible to clients. Medications were inspected and accounted for at the time of inspection. The first aid kit was checked and fully stocked with a certified manual. LPA reviewed the facility disaster plan. The facility disaster plan was current and in compliance with Title 22 at the time of visit. Staff records and P&I were presently available for immediate review and inspection. An exit interview was conducted, and a copy of this report was providedthe state’s words, verbatim · CDSS document, Jul 31, 2024

Type of visit: Required - 1 Year

On 07/30/2024 at 12:44 PM Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual required visit. (LPA) met with the Marcia Bailey for (2) developmentally disabled or mentally ill adults ages 59 and up. Currently the home has (2) clients.The facility is a one story structure located in a residential neighborhood and consists of the following: (3) client bedrooms, two (2) common bathrooms (1) living room area (1) dining area, (1) kitchen, an outside patio area and a front porch area. LPA Troy Watson toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser chairs and closet space was observed. Bed linens, comforters and bath towels were adequately stocked at the time of visit. The bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly.The bathtub was free of mold/mildew. There is adequate lighting, and sufficient toiletries are accessible to clients. The water temperature properly measured between 116 F and 117.2 F in the bathrooms and in the Kitchen.Because of time constraints inspection could not be completed at this time. Evaluation Report continues LIC 809-Cthe state’s words, verbatim · CDSS document, Jul 26, 2024

Type of visit: POC

On 12/18/23 1:50 PM Licensing Program Analyst (LPA), Regina Cloyd, conducted an unannounced visit to the facility listed above for the purpose of a plan of correction follow up visit and met with Marcia. LPA spoke with Administrator Nisha Forte over he phone. There was no residents here during the visit. On 11/27/23, LPA conducted an annual inspection at the facility and did not observe health screenings with TB results for two staff members and a medical assessment for resident #2. A deficiency was issued and the plan of correction was developed with the licensee. The licensee advised that she will email the documents by 12/12/23; though, she may have issues sending the medical assessment. As of 12/18/23, the medical assessment was not received. A violation for not resolving the deficiency warrants an immediate civil penalty of $600 and is hereby assessed, see LIC421FC. Note, a $100 per day violation will continue to be accrued until the licensee corrects the deficiency(s). An exit interview was conducted and a copy of this report and the LIC421FC was left with Marcia.the state’s words, verbatim · CDSS document, Dec 18, 2023

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Regina Cloyd made an unannounced visit, and met with staff, Marcia Bailey, to conduct an annual unannounced inspection using the CARE Tool. The facility is licensed to serve elderly ages 60 years and over. Approved capacity is for four (4) ambulatory residents, zero (0) non-ambulatory residents, and zero (0) bedridden residents. Structure: Facility is a one-story family home with three (3) bedrooms, (2) full bathrooms, living room/ dining area, and kitchen. A car port / shaded area is located on the front of the property; LPA observed two (2) bench to be used for resident seating. Total of two (2) exits; main exit located in living room, exit two is in bedroom #1. Front yard landscape is in good condition at time of visit. A locked closet/storage space located across from bedroom#3 is used for extra linens, towels, and hygiene supplies. Washer/Dryer appliances are located in the kitchen. There are no firearms in the home. Bedroom: Bedrooms are equipped with one bed per resident, night-stand, chair, and overhead lightning. Bathrooms: bathrooms have a working toilet, wash basin, tub/shower. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, fitted sheet, blanket and bedspreads. One fully charged fire extinguisher is located near the kitchen. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in kitchen drawer inaccessible and under lock. Smoke Detectors/Carbon Monoxide(s): Facility is equipped with three (3) operational dual/ hardwired smoke detectors and carbon monoxide. Appliances: Stove burners (gas), oven, microwave, and washer/dryer are in working condition. There is one working (1) refrigerator in the home and working cordless telephone is located in the living room. Toxins: Cleaning supplies and toxins are stored and locked in kitchen sink cabinet. Water Temperature: Hot water was tested in bathroom #2; temperature was 118.2 Degrees F. Medication, First-Aid Kit & Book: Designated centrally stored medication area was locked and located in a standing cabinet space located in the Living room. Sufficient bandages and one (1) tweezer. Facility has First Aid Kit, Manual thermometer and scissors. Pools/Jacuzzi & Pets: No bodies of water and no pets on these premises. 5 staff records were reviewed, 5 out of 5 staff records had current first aid certificates. Two staff were interviewed. 2 resident records were reviewed and, 2 out of 2 residents records had Admission Agreements. Two residents were interviewed. During record review, LPA did not observe 2 out of 4 health screening reports for staff, which poses a potential health and safety risk to the persons in care. During record review, LPA did not observe documentation of a medical assessment, signed by a physician, made within the last year for R#2. Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, technical assistance provided, and plans of corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Marcia Bailey.the state’s words, verbatim · CDSS document, Nov 27, 2023

The state marks this report as 15 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.