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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 052700992
Report Date: 11/01/2021
Date Signed: 11/22/2021 08:21:25 AM

Document Has Been Signed on 11/22/2021 08:21 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:FOOTHILL VILLAGE SENIOR LIVINGFACILITY NUMBER:
052700992
ADMINISTRATOR:BITLER, MAUREEN H.FACILITY TYPE:
740
ADDRESS:1400 FOOTHILL VILLAGE DRIVETELEPHONE:
(805) 801-0404
CITY:ANGELS CAMPSTATE: CAZIP CODE:
95222
CAPACITY: 78CENSUS: 49DATE:
11/01/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Hope Bitler, Executive DirectorTIME COMPLETED:
03:00 PM
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An office meeting was conducted today in the Sacramento Regional Office via Microsoft Teams. The purpose of this meeting was to HAI recommendations for COVID mitigation and to get an update regarding staffing concerns. Present at the meeting were Regional Manager (RM) Krystall Moore, Licensing Program Manager Stephenie Doub, Shantala Ahanya, CDPH HAI, Roselynn Muzzy, Regional Vice-President Integral, Josh Allen and Monica Santos, RN consultant for Integral, Wyatt Mello, Licensee, Hope Bitler, Executive Director and Angelica White, Resident Care-Coordinator.
The facility reported on this day there are 16 positive residents of which 5 have cleared with 2 deaths. Three residents are currently in the hospital due to COVID. There are 9 staff positive of which 4 have cleared.
Recommendations discussed:
  • low vaccination rate of staff and residents
  • visitations during the outbreak
  • use of PPE
  • Training of staff, donning and doffing
  • Fit testing of all staff, seal check training
  • Ensure separation of staff working with COVID positive residents from other staff
  • staffing concerns
The facility agreed to do the following:
  • have all staff fit tested or trained to do seal check by the end of the week 11/5/2021
  • all staff will receive training of donning and doffing by 11/5/2021
  • facility will conduct random spot checks of staff in donning and doffing ongoing
  • facility will send line list to CCL daily
  • Facility will provide staffing schedule daily and how gaps in staffing schedule met
  • Facility will provide staffing plan to CCL by close of business 11/2/2021
No deficiencies cited during this visit. An exit interview was conducted with Executive Director Hope Bitler and a copy of this report was provided via email. Confirmation read receipt confirms receipt of the report
SUPERVISORS NAME: Krystall Moore
LICENSING EVALUATOR NAME: Stephenie Doub
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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