Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Johnson arrived at this facility unannounced to conduct a case management visit. This visit is to deliver a civil penalty regarding substantiated serious bodily harm allegations. LPA met with Tannch Koayen /M. Walters and explained the purpose of the visit.

On August 6, 2021, the allegation, “Resident received a burn while in care” was substantiated, and the licensee was cited for violating California Code of Regulations (CCR) Title 22, § 85077(a) for not providing necessary personal assistance and care, as indicated in the needs and services plan, with activities of daily living including but not limited to dressing, eating, and bathing, etc.

The investigation determined that based on the incident report dated June 1, 2021, on Saturday May 29, 2021, at about 3:00 p.m., the facility staff smelled gas in the house, and everyone was removed from the house immediately. Pacific Gas and Electric Company (PG&E) was called immediately, and they shut off the gas. The PG&E technician then checked the house and noticed one of the cooker burners was not tight and they tightened it. The PG&E technician then turned the gas back on and reset all the settings (stove, water heater, and other). Per PG&E service note, the call was completed at 4:32 pm on May 29, 2021.

On Monday May 31, 2021, Staff was in the process of giving a Resident (R1) a bath in the tub. R1 reached for the faucet and turned it to the hot water.