Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra conducted a case management visit to cite deficiencies discovered during a complaint investigation #21-AS-20220722161626 and met with House Manager Chris Guevarra.

LPA learned through records review and interviews on 7/26/22 with House Manager Chris Guevarra and Licensee Tony Guevarra that facility did not have available copies of dated menus served in facility file for LPA’s review. On 7/27/22 Licensee provided weekly menus, but they were not dated per regulation. During today’s visit, LPA/House Manager observed a weekly menu located on the facility refrigerator. LPA discussed with House Manager the importance of generating weekly menus a week in advance, dated and keep on facility file for at least 30 days.

LPA also followed up on a self-incident report submitted to CCL on 8/15/22. Per incident report, on 8/10/22 around 10:45pm client (C1) went out in the smoking area with another client (C2) when C1 was trying to go back in their room C2 was stretching their legs, C1 tripped and fell on the floor, C1 couldn’t get up and C2 called House Manager for help. House Manager called 911 after assessing C1 was transported to Santa Rosa Memorial Hospital where they were diagnosed with broken hips and was needing surgery. C1’s responsible parties were notified. During today’s visit, LPA conducted confidential interviews with staff and clients. Per House Manager, the facility was informed that C1 had surgery last week and was going to be relocated to North Bay Rehabilitation in Petaluma, Ca for about a month to get recover. Internal investigation conducted by facility and LPA follow up concluded that incident was an accident occurred between clients and the facility followed regulations.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.