Post-licensing visit·July 31, 2025

At approximately 9:00 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required Post Licensing Visit and was greeted by acting Administrator Karen Sims. Caring Hands at Cloverdale is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents, six (6) of whom may be bedridden. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were four (4) residents in care and one (1) staff members on-site. At approximately 9:15 LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:00 AM, LPA toured the facility with acting Administrator Sims. All exits were clear and unobstructed. The facility's one (1) fire extinguishers was last serviced and tagged on 10/11/2024. Food supply was sufficient. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills monthly. The last disaster drill was conducted on 7/24/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 10:45 AM, LPA reviewed four (4) resident files. Three (3) of four (4) resident files were observed to not have current LIC625 Appraisal/Needs and Services Plans. All other required documentation was observed in the residents' files. A Technical Violation will be issued. LPA reviewed three (3) staff files. Two (2) of three (3) staff files were observed to be missing annual training documentation. A Technical Violation will be issued All other required documentation was observed in the staff files. LPA spot checked Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Karen Sims’s Administrator Certification 6077091740 is current with an expiration date of 6/11/2027. LPA requested the following documents be submitted to Community Care Licensing by 8/15/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance No deficiencies cited during today's visit. Exit interview conducted. Copy of report, LIC 9102s Technical Violations, 811 Confidential Names provided to Acting Administrator Sims. Signature on form confirms receipt of documents.