Facility Evaluation Report

Licensing Program Analyst (LPA) Canela arrived unannounced, to conduct a Case Management visit and review resident R1's room #3 that was recently approved to be used for bedridden by the Vallejo Fire department. LPA will update the facility license to reflect changes. This facility is vendor by North Bay Regional Center.

Licensee Rose Devera arrived towards the end of the visit and LPA went over visit observations. LPA consulted with facility and reminded them to not put any items near any doors, so that doors can open to their full potential for fire safety reasons. During the visit, the small box was removed and facility was advised of the regulation and citations that may be issued, along with civil penalty fines if noncompliance continues.

During todays visit LPA reviewed food in the refrigerator and confirmed the dishwasher and oven were not properly working. LPA was notified of facility issues and LPA arrived to the facility to go over the concerns.

LPA observed staff bedroom not locked and there were prescription medication accessible and a bottle of cleaner in master bedroom bathroom and citations were issued.

LPA requested facility to send in all hospital discharge records for resident R1. LPA went over facility requirements regarding R1 and R2's care.

Facility to send in care plans for both R1 and R2.

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 were provided.

Exit interview conducted with Rose Devera, Licensee/Administrator. This report was emailed to facility.