Grace Home Tavel

Type of visit: Required - 1 Year

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Grace Home Tavel Residential Facility for the Elderly unannounced to conduct an Annual Inspection. LPA rang doorbell and was greeted by staff at the door. LPA introduced self and stated purpose of the visit. LPA was granted entry and asked to sign in the Visitors Log. Staff notified Administrator, Jennifer Hanh of LPA visit and met with LPA at the door. Administrator then accompanied LPA during inspection. LPA conducted a tour of the facility, both inside and outside, and observed the following: Facility: LPA was informed the current census is four (4) at time of visit. The facility is licensed for six (6) residents. Two (2) ambulatory residents and four (4) bedridden residents. There is a Hospice Waiver in place. The facility is approved for 4 Hospice residents. LPA observed that the facility is operating in the capacity and conditions approved by Community Care Licensing (CCL). Physical Plant: LPA observed the facility's temperatures to be comfortable. Water temperature was measured at 118.0 degrees Fahrenheit. Showers and toilets are functional. Each bathroom equipped with grab bars and sufficient paper and hand hygiene supplies. Linens and hygiene items observed are sufficient for the number of residents in care. Each resident room is equipped with regulated furniture, lamps that provide appropriate lighting for residents comfort and safety. The facility is equipped with operational smoke alarms and carbon monoxide detectors. Fully charged fire extinguishers - last inspected June 2022. LPA reviewed the facility's Emergency Disaster Plan and Fire Drills and observed that the facility conducts quarterly Fire/Earthquake Drills - last drill took place in February of 2023. Food Service: Nonperishable and perishable food is sufficient for number of residents in care. Food is being prepared and stored properly. Facility has a variety of food available for residents according to the posted food menu. LPA observed staff preparing lunch for residents. Care & Supervision: Facility has sufficient care staff as regulated. Toxic and sharp items are kept inaccessible to residents in care and stored and locked in a cabinet adjacent to the kitchen. Record Review and Resident/Staff Files: LPA reviewed records for two (2) residents currently residing at the facility. Resident records are complete with updated Physician Reports and Needs and Services Plans. LPA also reviewed staff files and confirmed that staff records reflect current CPR/First Aid Certification and Criminal Record Clearance. The Administrator's Administrator Certificate is in good standing. Administration: Disaster/Evacuation Plan, Long Term Care Ombudsman Poster, Administrator Certificate, Resident Personal Rights, and facility license are posted in a common area in the Facility. Emergency Disaster Plan is current. Medication/Medical Related Services: LPA observed that the residents' medication is centrally stored and locked in a file cabinet near the staff office. LPA reviewed all the residents' medications and compared it to the facility's Medication Administration Report (MARs) and Centrally Stored Medication Log. No medication errors observed. Based on today's inspection, no deficiencies were observed. Exit interview conducted and copy of this report was provided to Administrator/Licensee Jennifer Hanhthe state’s words, verbatim · CDSS document, Jun 16, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Bernadette Allen conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. I met with Administrator Jennifer Hanh. An initial application to operate an Residential Care Facility Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 3/14/2022 for a total capacity of six( 6) four (4) bedridden and two (2) non ambulatory. Fire clearance was granted on 04/14/2022. LPA Allen observed the following: Structure: Facility is a house with five (5) resident bedrooms, three(3) resident bathrooms, living room, dining area and kitchen. There was an attached two car garage in the front of the house. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway a to control entire house. Bedrooms: Master bedroom and bedroom #3 can be used for bedridden only per fire clearance. All bedrooms including the master bedroom and bedroom #3 will accommodate bedridden resident and are adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, Bathrooms: All three (3) bathrooms have working toilets, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 118.0 degrees Fahrenheit. Kitchen/Laundry: The kitchen has adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen drawer next to sink. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. Kitchen.. There was sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located near the garage. Laundry detergents and cleaning supplies were observed in closet near the garage secured in a locked closet.. Living/Family room: There was a living/family room with a TV and adequate seating for all clients. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outside: There is currently covered seating area in the front of the house and patio cover will be delivered on 5/19/2022 for backyard. There is a gate on the right side and left side of the property with a self-latching from the exterior doors. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the main hallway. General items: There was fire extinguishers and carbon monoxide detectors are in good conditions. Client records will be stored in a locked cabinet in the family room area. First Aid kit with required components are located in kitchen drawer. Medication will be locked in a cabinet in living/dinning area. LPA observed a facility phone and it was verified to be operational . Emergency water supply and food was observed. An exit interview was conducted, and a copy of this report was given to the administrator Jennifer Hanh-Administratorthe state’s words, verbatim · CDSS document, May 18, 2022

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Jennifer Hahn Interview Method: Telephone interview On February 23, 2022, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 23, 2022