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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700574
Report Date: 12/01/2021
Date Signed: 12/01/2021 02:53:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ANSEL PARK SENIOR LIVING COMMUNITYFACILITY NUMBER:
312700574
ADMINISTRATOR:BERKELEY, LORIFACILITY TYPE:
740
ADDRESS:1200 ORCHID DRIVETELEPHONE:
(916) 250-0770
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:100CENSUS: DATE:
12/01/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lori Berkeley, Executive DirectorTIME COMPLETED:
02:15 PM
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An informal conference was conducted today in the Sacramento Regional Office. The purpose of this informal conference meeting is to discuss the the number of complaints the Department has received for this facility since Licensure. This facility was licensed on 11/14/2019 and has received 9 complaints. There are currently 3 open complaints being investigated at this time.

Present in the meeting is Licensing Program Manager Laura Munoz, Licensing Program Analyst De Anna Williams-Lyons, Executive Director Lori Berkeley and Regional Director of Operations, Jim Stacy. The informal conference and administrative action process was explained during this meeting.

Topics of discussion during today’s informal conference included, resident medication management, staff training, regulation clarifications, re-assessments and resident record documentation. In addition, COVID vaccination mandate as well as mitigation procedures were also addressed during today’s meeting.

No citations were issued today.

Exit interview conducted. Copy of report given to Lori Berkeley.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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