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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700996
Report Date: 04/04/2024
Date Signed: 04/04/2024 05:48:28 PM


Document Has Been Signed on 04/04/2024 05:48 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:WELLQUEST GRANITE BAY TENANTCO LLCFACILITY NUMBER:
312700996
ADMINISTRATOR:MICHAEL TALANIFACILITY TYPE:
740
ADDRESS:9747 SIERRA COLLEGE BLVDTELEPHONE:
(916) 864-9800
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:135CENSUS: 119DATE:
04/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Michael Talani, Administrator TIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an annual inspection and met with Marguerite Guerrero, Business Office Director and then Mike Talani, Administrator, and explained purpose of inspection. The facility is licensed for 135 residents. Currently there are (34) residents in the Memory Care Unit, (55) residents in Assisted Living who are receiving services and (30) residents not on services. There are (5) residents under hospice care.

LPA and Administrator toured the interior of the facility including the common areas, main kitchen, gym, arts and crafts studio, sports bar, salon, theater, game room, physical therapy room and (2) resident rooms. In all areas toured, there were no health and safety concerns. Outside, there are several enclosed patios, a putting green, bocche ball and a pool that is gated/locked. LPA observed 2+day perishable food and 7+day non-perishable food in the kitchen. Freezer/refrigerator temperatures are checked twice daily. Hot water temperatures are checked weekly, throughout the facility- all temperatures recorded were within the 105-120*F. One delayed egress door was tested and found in working order. Fire extinguishers were last serviced 3/6/24. All required postings are in the common areas. RCFE Administrator certificate # 6039623740- exp 5/4/2024 is in the process of being renewed.

LPA reviewed (10) resident files for Memory Care and (10) resident files for Assisted Living. All files contain current physician's reports and care plans and are complete with other required documentation. Medications were reviewed for (2) residents with Nekia Xavier, LVN Health and Wellness Director. Medications are being administered as ordered and documented in the QMAR. LPA reviewed (10) staff files. All staff is cleared/associated to the facility. All staff completes the required training through an approved on-line vendor and documentation was on file. LPA observed current First Aid/CPR documentation. Vehicle service were reviewed also on (2) vehicles.

LPA requested that an updated copy of LIC500, LIC308 and current liability insurance be emailed by 4/11/24. There are no deficiencies issued during today's inspection.
Exit interview. Copy of report provided to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024
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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