Spring Creek Lodge

87109 Transferability of License(b)The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business... This requirement is not met as evidenced by:Based on interview & record review, the licensee did not comply with the section cited above in the licensee did not notify Community Care Licensing within thirty (30) business days of the transfer of the facility to a Limited Liability Corporation which poses a potential health, safety or personal rights risk to persons in care.

87156 (b)(1)(F) Licensing Fees. In addition to fee set forth in subdivision , the department shall charge the following.. licensee fails to pay the annual licensing fee on or before the due date as indicated by postmark on the payment. This requirement is not met as evidenced by: Based on record review, during abbual visit conducted on 8/14/25, the licensee did not comply with the section cited above in paying the annual fee in the amount of $495, but did not submitted written plan, which poses a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on LPA/staff during abbual visit conducted on 8/14/25, facility failed to submit requested written plan regarding construction project about how the facility will ensure the residents’ safety and personal rights, which poses a potential ealth, safety or personal rights risk to persons in care.

§1569.269 Enumerated rights; severability (a) Residents of RCFE shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other people. This requirement has not been met as evidence by: Based on LPA’s/staff observations during abbual visit conducted on 8/14/25, the facility staff assisted residents in care using inappropriate comments by referring to them as "this one", which poses/posed a potential health, safety or personal rights risk to persons in care.

Based onBased on LPA’s/staff observations, the facility staff assisted residents in care using inappropriate comments by referring to them as "this one", which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in not paying the annual fee in the amount of $495, which poses a potential health, safety or personal rights risk to persons in care.

Maintain fire clearance before retaining specified persons

Based on LPA's/staff observation, interview and records review, the licensee did not comply with the section cited above in there is a lock in the exit gate, which it is identified as an emergency exit, which poses an immediate health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on LPA/staff attempted to flush the toilet in the bathroom across from room number six. Electric face plate located in the kitchen is broken and it needs to be replaced, During last annual visit conducted on 8/14/24, LPA cited fence in backyard needed to be repaired, handrails broken and base of handrails cracked. There was a frame of wood with nails exposed which poses an immediate health, safety or personal rights risk to persons in care.

Mark taps at high-temperature threshold

Based on LPA's/staff observation, the licensee did not comply with the section cited above in that water temperature in sink accessible to residents in care measured at 129.2 and 126.5 degrees F in the bathrooms, which poses/posed a potential health, safety or personal rights risk to persons in care.

Immediate disposal of contaminated food

Based on LPA's/staff observation a bag of ten carrots sitting on the kitchen counter it was spoiled and 18 cans of thick and easy were expired as of 1/31/25 which poses an immediate health, safety or personal rights risk to persons in care.

Address and clearance obligations before facility work

Based on LPAs and Admin observation, interview, and record review, the licensee did not comply with the section cited above in that staff (S1) did not have fingerprint clearance and not associated to the facilitywhich poses an immediate health, safety or personal rights risk to persons in care.

Mark taps at high-temperature threshold

Based on LPAs observation, the licensee did not comply with the section cited above in that water temperature in sink accessible to residents in care measured at 158 degrees F in the kitchen, LPA could not get a hot water reading in the bathroom across from room six, the water never got hot after running the water for four minutes which is not within the allowable range of 105 to 120 degrees F, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPAs and Admin record review, the licensee did not comply with the section cited above in that R1 is indicated as bedridden on their physician's report. However, facility does not have fire clearance for beridden residents. Admin unable to produce proof of notification to the Santa Rosa Fire Dept, which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on LPAs and Admin observation, the licensee did not comply with the section cited above in that LPAs observed window in back bathroom in hallway to be broken, does not stay up when lifted, will not stay open. LPAs observed hole in wall on left side of the refrigerator. Backyard deck in disrepair, handrails broken and base of handrails cracked. Fence in backyard also in disrepair. Planks separated from fence with nails exposed. Large fence surrounding the perimeter of the facility is also in disrepair, boards separating from fence and nails exposed. Vents on side of house have gaps and black film substance. Per LPAs conversation with Admin they agree to repair, which poses/posed a potential health, safety or personal rights risk to persons in care.

Document behavioral expression and related causes

Based on LPA observation and record review the licensee did not comply with the section cited above in five out of six residents' (R1, R2, R3, R4 & R5) care plans were not updated within the last 12 months, which poses/posed a potential health, safety or personal rights risk to persons in care.

Obtain baseline medical assessment before resident admission

Based on LPA record review and interview with administrator, the licensee did not comply with the section cited above in one out of six residents physician's report (R2) was not updated as stated per regulations, which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on LPA and administrator observation and interviews with administrator back deck has wood scrap piles with nails protruding due to remodeling, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.