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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 280109377
Report Date: 07/23/2024
Date Signed: 07/23/2024 04:06:17 PM

Document Has Been Signed on 07/23/2024 04:06 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:VETERANS HOME OF CALIFORNIA TRUMAN HALLFACILITY NUMBER:
280109377
ADMINISTRATOR/
DIRECTOR:
THERESA JONESFACILITY TYPE:
740
ADDRESS:300 CALIFORNIA DRTELEPHONE:
(707) 944-4884
CITY:YOUNTVILLESTATE: CAZIP CODE:
94599
CAPACITY: 48CENSUS: 29DATE:
07/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:57 AM
MET WITH:Theresa Jones, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) J. Macias arrived unannounced to conduct an Annual Required Inspection of the Veterans Home of California, Truman Hall and met with Administrator, Theresa Jones.

LPA initiated a tour of the facility around 12:30pm and made the following observations: Facility was at a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. The facility had sufficient lighting in common areas, hallways, and bathrooms for use by all. Water temperature in sinks accessible to residents in care measured at 107.2, 107, 106.5 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Laundry room accessible to residents was clean and in good repair. Medications are stored in a medication room and inaccessible to residents in care. Cleaning supplies are stored in locked janitor closets. Facility has at least two days of perishable and one week of non-perishable foods that appeared to be of quality and was stored per regulation.

Fire extinguishers were last serviced January 4, 2024. Carbon Monoxide detectors were tested and operational. Facility has a fire alarm system that is maintained by an outside vendor and was last inspected on June 26, 2024. Most recent fire/disaster drill was conducted on June 28, 2024.

At approximately 1:30pm, LPA reviewed five staff files and five resident files, which were all found to be well organized, thorough, and contained the required documentation. Staff have required First Aid and CPR certification
. Training records were reviewed. Medications and medication records were reviewed and found no deficiencies. Required postings were observed.

Administrator Certificate for Administrator, Theresa Jones 6063677740 expires 8/22/2024.

Administrator to submit updates of the following documents by 8/23/2024:
LIC 500 Personnel Summary, LIC308 Designation of Facility Responsibility
Copy of Liability Insurance, LIC 610 Emergency Disaster Plan (If changes)
Infection Control Plan (If changes)

No deficiencies cited during this inspection and no citations issued. Exit interview conducted with Administrator, Theresa Jones.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jacqueline Macias
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
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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