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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701286
Report Date: 10/24/2024
Date Signed: 10/24/2024 12:57:14 PM

Document Has Been Signed on 10/24/2024 12:57 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BEATRICE HOME CAREFACILITY NUMBER:
342701286
ADMINISTRATOR/
DIRECTOR:		CLARK, BEATRICEFACILITY TYPE:
740
ADDRESS:1014 FERNANDO WYTELEPHONE:
(916) 270-3961
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 6CENSUS: 5DATE:
10/24/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:36 AM
MET WITH:Beatrice ClarkTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 10/24/24, Licensing Program Analyst (LPA ) arrived unannounced to this facility to conduct a case management visit. LPA initially met with staff on duty (S1) and stated the purpose of the visit. Beatrice Clark, Administrator (AD) was notified of the visit and arrived shortly after. Present during today's visit were 5 residents in care with 1 staff on duty (S1).

The purpose of this visit is to cite deficiencies found during a complaint investigation visit (complaint #27-AS-20241017164426) on 10/24/24. During this visit, LPA and AD conducted an inspection of the facility including resident bedrooms, bathrooms, kitchen, dining, livingroom, garage and outside perimeter.

During the inspection of the kitchen, LPA observed cleaning chemicals stored under the sink. The storage under the sink does not have a lock and the chemicals are accessible to residents in care. S1 removed the cleaning chemicals and stored them in a locked closet in the hallway leading to the garage door. During an inspection of the bathroom located in the resident bedroom hallway, LPA observed 2 disinfectant sprays and a cleaning spray bottle under the bathroom sink storage. This storage was unlocked and accessible to residents in care. S1 removed the chemical items and store them inside a locked closet in the hallway leading to the garage door. Photos were taken for reference. LPA also inspected the kitchen pantry and refrigerator and freezer. LPA did not observed medications stored the refrigerator.

LPA measured the hot water in the hallway bathroom and was measured at 123*F. LPA and AD measured the hot water in the master bathroom and was measured at 123*F.

LPA and AD also inspected the outside of the facility. Fence and gates were observed to be in good repair at this time. LPA observed the gate was locked by the evidence of the latched being tied with a string. AD attempted to loosen up the tie but were not able to. Per AD there was a former resident who tends to climb up the fence but has moved out more than a week ago. AD stated they forgot to unlock the gate. During this visit, S1 cut and removed the string off the gate latch.

Per California Code of Regulations (CCR) Title 22, deficiencies are being cited today on the attached LIC 809-D page.

An exit interview was held with Administrator Beatrice, and a copy of report and appeal rights were provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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 3
Document Has Been Signed on 10/24/2024 12:57 PM - It Cannot Be Edited


Created By: Arvin Villanueva On 10/24/2024 at 12:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2024
Section Cited
CCR
87705(f)

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87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia:(1) Knives,...tools and other items that could constitute a danger to the resident(s).(2)... cleaning supplies and disinfectants. This requirement was not met as evidenced by:
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During this visit, staff on duty removed the cleaning chemicals and store them in a locked closet.
Per Administrator they plan to train staff and put lock for the storage under the sink.
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Based on observations, the licensee did not comply with the regulation cited above. LPA Villanueva observed cleaning supplies under the kitchen sink and under the bathroom sink area accessible to the residents in care. This poses an immediate health, safety, and personal rights risk to residents in care.
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Per Administrator, they will send their plan to the Department by POC due date.
Then send the staff training once completed by 10/31/24.
Type A
10/25/2024
Section Cited
CCR87303(e)(2)

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(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
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Per discussion with Administrator,
initially, check daily for a week and send readings to LPA by 10/31/24. After that, check hot water every month to continue monitoring hot water.
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Based on observation, the licensee did not comply with the regulation cited above. Hot water in 2 bathrooms and kitchen sink were measured betwween 123*F and 125*F. This poses an immediate health, safety, and personal rights risk to residents in care.
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Per Administrator, they will send their plan to the Department by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stephen Richardson
LICENSING EVALUATOR NAME:Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/24/2024 12:57 PM - It Cannot Be Edited


Created By: Arvin Villanueva On 10/24/2024 at 12:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2024
Section Cited
CCR
87705(l)(6)

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(6) Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents.
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The staff has already removed the lock. The Administrator/Licensee agrees to send the date and time of when she will provide a training on fire safety regarding exits and fire department fire access by the POC date.
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Based on observation, the licensee did not comply with the regulation cited above. LPA observed the gate latch to be locked as evidenced by being tied with a string.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stephen Richardson
LICENSING EVALUATOR NAME:Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2024


LIC809 (FAS) - (06/04)
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