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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005900
Report Date: 08/30/2024
Date Signed: 08/30/2024 02:24:34 PM


Document Has Been Signed on 08/30/2024 02:24 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:MEADOW OAKS OF ROSEVILLEFACILITY NUMBER:
317005900
ADMINISTRATOR:JESSICA SANDERSFACILITY TYPE:
740
ADDRESS:930 OAK RIDGE RDTELEPHONE:
(916) 774-0200
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:108CENSUS: 78DATE:
08/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jessica SandersTIME COMPLETED:
02:45 PM
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On 8/30/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit and met with Director, Jessica Sanders.

LPA was following up on incident reports submitted for the following resident issues.

It was reported that on 8/11/24 and 8/18/24, R1 had falls which resulted in skin tears. LPA and Director reviewed the incidents and R1's current fall prevention strategies. Director reported R1 has had no further falls. Since 8/18/24, R1 has continued to adjust to their residency, has had medication adjustments and received physical therapy. LPA observed R1, who resides in memory care. R1 appears to have their current care needs met.

LPA also followed up on a incident that occurred on 8/10/24 where it was reported that R2 entered the room of R3. R3 told R2 to leave and an altercation resulted with R2 hitting R3. Residents were separated and residents were assessed. Director reported that R2 resides in a different memory care unit that R3. R2 was accompanied by a med tech into the unit in which R3 resides. While the med tech was on the phone , R2 wandered away and entered R3's room. R2 in not a hazard to R3 at this time. LPA and Director discussed supervision communication for when the primary supervision is otherwise occupied.

LPA observed these three residents in care. No health, safety or supervision issues are noted at this time.

As a result of today’s inspection, no deficiencies were noted. Report reviewed. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024
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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