<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280109377
Report Date: 03/17/2022
Date Signed: 04/27/2022 01:31:14 PM

Document Has Been Signed on 04/27/2022 01:31 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
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: 31DATE:
03/17/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Angela Briles, Acting AdministratorTIME COMPLETED:
02:14 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LIcensing Program Analyst Jill Nakagawa arrived unannounced to do an Annual Inspection of the Veterans Home of California, Truman Hall, on 3/17/22 at approximately 9:37 AM. LPA met with Angela Briles, who is currently completing the paperwork to take over as Administrator of the facility. The Inspection is focused on Covid-19 Protocols.

The facility is nestled amongst several other facilities (not within DSS licensure) on the Yountville Campus. Covid-19 screening protocols are taken care of at the front gate. A questionnaire and temperature check are done by the guard at the gate. Covid-19 Rapid Response Testing is available at the gate, if needed.

LPA met with AB at the Administration Building where "New Administrator" paperwork was collected. Then AB took LPA over to Building F, Truman Hall, where the RCFE facility is housed. There are currently 31 residents. They are presently under isolation due to a staff person testing positive. Testing will be done on 3/18 and the isolation will continue until 3/26 unless other positive cases are detected. Residents are receiving meals and medications in their rooms. The Activities/Therapy staff are providing activities and outreach on a one-to-one basis. When isolation is over the residents will be able to return to the Dining Room, a short walk under a covered walkway.

Rooms are outfitted with required bed, chair, nightstand and light. Also have desk, dresser. There are common bathrooms, which were clean and outfitted with handrails, soap and paper towels. Water temperature is tested at least once a month. The current readings were between 119.4 F and 120.3 F. There were signs in each bathroom illustrating Covid-19 protocols for handwashing. Exit doors had reminders about Covid-19 protocols of social distancing and wearing masks.

There were no deficiencies found during this inspection and no citations issued.
Exit interview completed with Angela Briles.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1