312700042-2-14-2024-59-AS-MPAS-D2FUY3-20240214145915

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 312700042
Report Date: 02/14/2024
Date Signed: 02/14/2024 02:59:49 PM

Document Has Been Signed on 02/14/2024 02:59 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	312700042
ADMINISTRATOR:	MARK MORRIS		FACILITY TYPE:	740
ADDRESS:	567 3RD STREET		TELEPHONE:	(916) 409-4150
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	132	CENSUS: 68	DATE:	02/14/2024
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Mark Morris		TIME COMPLETED:	03:00 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	An informal conference was conducted on Wednesday February 14, 2024, in the Sacramento North Regional Office. The purpose of this informal conference meeting is to discuss the high volume of complaints/ inability to remain in substantial compliance with the regulations/or specific incidents that has occurred in the last 12 months. Present in the meeting is Licensing Program Manager (LPM) Maribeth Senty, Licensing Program Analyst (LPA) Melissa Parks, Owner Rick Beasley, Regional Manager Sabrina Boyle and Administrator Mark Morris. The informal conference process was explained during this meeting. The facility has been cited 13 times in the last year. The facility was cited under the following regulations: Care of persons with Dementia, not having a skilled professional administer injections, observation of resident, monitoring the activities of residents, personal rights, medication mismanagement, not following PRN directives, and insufficient staffing. The facility was cited for 9 Type A citations, and 4 Type B citations. The licensee was told that this Informal conference is a part of the Administrative Action process and that further citations may result in an elevation to a formal non-compliance conference, which could lead to a referral to the Department's legal division for possible revocation of license.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SUMMERSET LINCOLN ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 312700042
	VISIT DATE: 02/14/2024

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
26
27
28
29
30
31
32

Issues discussed during the meeting were:
· Current open complaints (3)
· Adequate staffing
· Nursing Schedule
· PRN medication
· Medication Administration

The facility has stated they will do the following to achieve continued and substantial compliance:

Reassessing residents after falls, updating care plans, care conference with POAs if resident requires higher level of care or 1:1 supervision
Staffing based on acuity, reassessments every 3-6 months or as needed
Nursing sign-in book, utilizing on-call nurses if needed
Reviewing PRN authorization forms for all residents
Reviewing MARs to ensure they match doctors orders

No deficiencies were cited during today’s meeting.

An exit interview was conducted. A copy of this report was provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2