Routine inspection·January 20, 2023

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Rosemarie Vister, live-in staff . Administrator was unavailable during day and time of inspection. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. LPA toured the facility and observed a visitor sign-in sheet, thermometer, and hand sanitizer. The facility food supply was observed per regulation. LPA observed COVID-19 precaution postings, liquid hand soap and paper towels available in bathrooms. During this inspection, the facility received citations and civil penalties for 3 of the various deficiencies observed. Do to time constraint, LPA will return unannounced at a later date to review additional items and complete the inspection. LPA requested the following updated forms to be submitted to Community Care Licensing by 02/20/2023: · LIC 308 Designation of Facility Responsibility (1 person per form) · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents) · Copy of liability insurance · LIC 610E Emergency Disaster Plan · Copy of current Administrator's Certificate · Copy of current Lease/Rental Agreement or Property Tax document showing control of property. Report continued on LIC809-C During this visit, LPA observed the following deficiencies (Photos Taken): LPA observed Resident (R1)'s bed to have full bed rails. LPA explained this is not allowed as it can be used as a form of restraint . Full bed rails are prohibited unless the facility requests an exception and is approved by the Department of Social Services, Community Care Licensing. Administrator stated over the phone they will submit an exception request to be reviewed for approval. During the inspection, it was revealed 1 of 2 live-in staff (S1) were out on vacation during 10/2022 to 01/11/2023. During S1's leave of absence, staff (S2) was working with individual (I1). Statements received confirmed I1 was working and providing services to residents in care during the time period mentioned. LPA verified on the facility Guardian Employee Roster and with the Santa Rosa Regional Office, Community Care Licensing, that I1 is not fingerprint cleared or associated to Fairfield Meadows. LPA explained prior to anyone working, volunteering, residing or being present in any part of the licensed facility, they are required to be fingerprint cleared and associated to the facility (verified on the Guardian Employee Roster). An immediate Civil Penalty in the total amount of $1000 was assessed for Individual (I1) who was working at the facility between Oct 2022 - 1/11/2023. I1 does not have a fingerprint clearance (total $500 civil penalty) and is not associated to the facility (total $500 civil penalty). Appeal Rights Provided. Deficiencies cited (see LIC809-D page) from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiencies and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Staff Rosemarie Vister, whose signature below confirms receipt of report.