496890095-10-31-2024-21-AS-DALO-DAKVSQ-20241031164156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 496890095
Report Date: 10/31/2024
Date Signed: 10/31/2024 04:42:01 PM

Document Has Been Signed on 10/31/2024 04:42 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:	ALLURE SENIOR CARE		FACILITY NUMBER:	496890095
ADMINISTRATOR/ DIRECTOR:	SHAUGHNESSEY, MERA		FACILITY TYPE:	740
ADDRESS:	2008 DENNIS LANE		TELEPHONE:	(707) 843-4090
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY: 6		CENSUS: 6	DATE:	10/31/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:35 PM
MET WITH:	Mera Shaughnessey-Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:55 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 (LPA) Alviso conducted a Required- 1 Year visit, on 10/31/24 at approximately 12:35pm, and met with Licensee/Administrator Mera Shaughnessey. There are currently six (6) residents in care; Currently there are two (2) residents on hospice care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Facility has an approved dementia plan of operation. Facility has a fire clearance approval by the Santa Rosa Fire Department for a total of six non-ambulatory and/or bedridden. The facility's last fire drill and evacuation drill was conducted on 10/1/24, on all shifts. Facility does have a generator for emergencies if needed. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. LPA reviewed six (6) resident files; All resident files were found to be complete. LPA reviewed five (5) staff files. LPA reviewed staff training. All five(5) staff have criminal record clearance, and are associated as required. All staff had required training. All staff had current First Aid and CPR Certification. All exits were free and clear of obstruction. Fire extinguishers, two(2), were serviced and tagged as required. There are nine(9) smoke alarms that are also carbon monoxide detectors; All smoke alarms are working as required. The backyard has outside patio, with furnishings for resident use, including areas providing shade for residents as needed. The facility was at a comfortable temperature for residents; Residents were observed to be watching television, listening to music, and engaging with the staff. Continued on LIC809C...

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ALLURE SENIOR CARE	FACILITY NUMBER: 496890095
	VISIT DATE: 10/31/2024

NARRATIVE

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LPA observed sufficient supply of food, perishable and non-perishable, for resident meals/snacks. Facility had sufficient furnishings for residents in care. The facility has sufficient lighting in all rooms, bathrooms, and common areas, including night lights. There was a sufficient supply of hygiene products, cleaning supplies, and paper products for use as needed. All bathrooms had grab bars, and non-slip mat/flooring for bathing/showering as needed; Every resident room has a bathroom that is able to provide showers as needed. There is a large bathroom with a open roll-in shower for resident use as needed. Facility has a sufficient supply of personal protective equipment(PPE). All medications were stored/locked and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care.

LPA is requesting the following documents be updated and submitted by 11/30/24:
LIC308 - Designation of Administrator Responsibility
LIC500 - Personnel Report
LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required)
Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash)
Copy of Current Liability Insurance
Resident Roster
Copy of current Administrator Certificate

No deficiencies cited today.
Exit interview conducted with Administrator Mera Shaughnessey.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC809 (FAS) - (06/04)

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