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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280109377
Report Date: 06/15/2021
Date Signed: 06/15/2021 12:14:18 PM

Document Has Been Signed on 06/15/2021 12:14 PM - 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:VETERANS HOME OF CALIFORNIA TRUMAN HALLFACILITY NUMBER:
280109377
ADMINISTRATOR:CHANELL VELLENOWETHFACILITY TYPE:
740
ADDRESS:300 CALIFORNIA DRTELEPHONE:
(707) 948-2516
CITY:YOUNTVILLESTATE: CAZIP CODE:
94599
CAPACITY: 48CENSUS: 29DATE:
06/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Channel VellenowethTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Angela Elliott arrived unannounced to conduct an annual inspection, today at approximately 9:25 AM, and met with Angela Briles Staff Services Manager III (OOC), Stephanie Weaver, Deputy Administrator, and Channel Vellenoweth, Chief of Domicillary Services. The inspection is focused on the Infection Control procedures and practices of the Veterans Home.

Upon arrival, the security guard at the check in station checked LPA's temperature and LPA was asked to complete COVID-19 screening questionnaire, and visitor sign in sheet. All staff and visitors are required to complete this process as well as residents who are returning from the community. LPA and staff toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. Common areas are set up for social distancing. Toxins are secured and inaccessible in locked areas throughout the facility. Housekeeping Services are assigned 6:00 AM-2:30 PM and available until 11:00 PM. LPA observed staff wearing masks and staff encouraging residents to wear their masks while touring the facility. Hand sanitizer is kept in the common areas and resident rooms. LPA observed COVID-19 postings throughout the facility including hand washing signs in public restrooms. LPA was made aware facility has a new mitigation plan that was provided to LPA.

LPA was also provided staff training records. Staff have been trained in COVID-19 protocols and have been N-95 Fit tested. LPA reviewed medication procedures and medication cart was secured. Facility has system in place to ensure medications are ordered regularly and adequate back up supplies are present. LPA observed the dining hall. Meals are provided by the large main kitchen on grounds. LPA observed residents socially distancing in line and getting their temperatures checked before coming into the dining area. Dining hall has floor and table markers to promote social distancing. Residents also have the option to pick up their meals and dine in their room. Temperature logs are maintained in the main kitchen and hand washing signs were present in the kitchen area. Per Chief of Domicilliary Services, they regularly share updates to protocols with the residents in house meetings as well as distributing letters to residents.
(See LIC 809-C)
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Angela Elliott
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: VETERANS HOME OF CALIFORNIA TRUMAN HALL
FACILITY NUMBER: 280109377
VISIT DATE: 06/15/2021
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Provider Information Notices (PIN's) from Community Care Licensing (CCL) are also available for residents to review. Residents are screened twice daily, staff observe for any changes. and resident's emergency contact information has been updated. The facility has a large supply of Personal Protective Equipment (PPE). Facility is conducting COVID-19 surveillance testing per CCL guidelines. LPA and Chief of Domicilliary Services discussed resident activities and visitation policies.

No deficiencies were found in the areas inspected, no citations issued during today's visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Angela Elliott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC809 (FAS) - (06/04)
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