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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701286
Report Date: 11/26/2024
Date Signed: 11/26/2024 12:00:22 PM

Document Has Been Signed on 11/26/2024 12:00 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: 4DATE:
11/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Beatrice Clark TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced on a subsequent visit. LPA Valerio met with two (2) facility staff members, and explained the purpose of the visit.

LPA Valerio observed the facility's regular day time staff, Etta Mae. LPA observed a new staff member. LPA Valerio took her name down and did not observed the resident on the associated staff roster.

According to Administrator Beatrice, the new staff member is not working but will soon be working after she is associated. Beatrice stated the staff went to get their fingerprints but they are waiting for the approval letter. Beatrice stated a previous LPA informed her staff can be present as long as they are not working with residents. Administrator Beatrice stated the staff was present for only two days and doing one to two hours of training.

LPA Valerio observed interactions and conversations with residents and staff. According to Resident 1 (R1), the new staff member has been helping R1 get better so that R1 can get out of here. R1 hugged the new staff member. According to a conversation with a family member of a resident and staff, staff informed the family member that they assisted Resident 2 (R2) with doing exercises yesterday.

Based on records review, observations, and interviews, the licensee allowed a facility staff to work in the facility without obtaining a cleared fingerprint clearance. The licensee was made aware an immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed. The licensee was made aware a civil penalty in the amount of $200.00 will be assessed on today's date due to the staff member being at the facility for two days.

An exit interview was held, and a copy of the report was provided. Appeal rights were provided. Failure to correct deficiencies may result in additional civil penalties.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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Document Has Been Signed on 11/26/2024 12:00 PM - It Cannot Be Edited


Created By: Christina Valerio On 11/26/2024 at 11:34 AM
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: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2024
Section Cited
CCR
87411(g)(2)

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87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (2) Request a transfer of a criminal record clearance... This requirement was not met as evidenced by:
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Licensee stated the administrator will take the staff member to get a fingerprint clearance today, 11/26/24. Licensee to send LPA Valerio proof by POC due date of 11/27/24.
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Based on observations, records review, and interviews, the licensee did not ensure 1 out of 2 staff present in the facility were fingerprinted and cleared. This poses an immediate health, safety, and personal rights risk to residents.
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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:Christina Valerio
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2024


LIC809 (FAS) - (06/04)
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