340312763-8-12-2020-27-AS-JMCY-BSF32L-20200812175208

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340312763
Report Date: 08/11/2020
Date Signed: 08/12/2020 05:53:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	MERCY MCMAHON TERRACE		FACILITY NUMBER:	340312763
ADMINISTRATOR:	MARY ERICKSON		FACILITY TYPE:	740
ADDRESS:	3865 J STREET		TELEPHONE:	(916) 733-6510
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95816
CAPACITY:	189	CENSUS:	DATE:	08/11/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kristina Wardlow - Facility Nurse		TIME COMPLETED:	12:00 PM

NARRATIVE

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On 08/11/2020 at 10:35 AM Licensing Program Analyst (LPA) McCrory began facility tour with Facility Nurse (FN) Kristina Wardlow via FaceTime. Due to COVID-19 precautionary measures, an in-person visit was not conducted. Below is a summary of pertinent information from the tele-visit.

Main Entrance

Sign posted on door stating "...no longer allowing visits until further notice, please call the front desk..."
Inner door only opens by receptionist or when an employee enters a code on keypad.
Hand sanitizing station at entrance and sanitizer outside North and South elevators.
Sign warning non-employees not to go further.
Receptionist takes temperatures and confirms answers from keypad screening questions for employees, essential staff (i.e. delivery drivers), etc.

Personal Protective Equipment

Personal Protective Equipment (PPE) distributed to staff everyday, including new masks. PPE storage is in FN's office. Items stored are gloves, masks, isolation gowns, disposable face shields, reusable face shields, safety glasses, hand sanitizes by the gallons, including 2 ounce bottles for staff to keep in pocket during the day.
All staff wearing masks.

Touring Physical Plant

Dining room has reopened for all day dining.
Coffee and refreshment bar available for residents in hallway.
Staff can exit from back doors only however are required to come in through the front door for screening.

continued...

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jasmine McCrory	TELEPHONE: (916) 214-5020
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: MERCY MCMAHON TERRACE	FACILITY NUMBER: 340312763
	VISIT DATE: 08/11/2020

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Touring Physical Plant continued...

June's place is almost half of the second floor and the building is shaped like a doughnut. The building goes all the way around.
Facility has north and south elevators and both were recently completely rebuilt.
Movie room (used to be art studio).
23 rooms total for June's place.
In June's place Staff does the dishes and there is a stove and oven located in the kitchen which is used when food comes upstairs for distribution or for cooking activities.
Chapel is located in the facility.

Charting

Med carts are in the hallway outside of med room and are locked with an electronic keypad - staff have their own code to unlock the cart.
Electronic MARS - each med cart has a locked chromebook holding Resident date and a paper copy is available as well.
Temperature nurse comes in at 5:30 AM and screens employees and residents(prior to the arrival of front entrance Receptionist).
Keypads in hallways are for care providers to document care.
ALIS - assisted living intelligent software Medtelligent software is used by facility.
Caregivers and nurses go into the rooms and care staff takes care of housekeeping.

Social Distancing

Facility is not social distancing residents any longer. Resident's are not wearing masks, FN does not consider Residents to be a risk to each other. Facility has notified families and responsible parties to allow Residents to have fellowship among each other.
Signs on door stating: " isolation after doctor's visits."
Assisted living has outdoor visitation scheduled 6 days a week (Saturdays are vacant in preparation for future June's place visitation).
New residents get tested and quarantined in apartments per PIN-20-23-ASC.
Conferences with families start next week to schedule June's place visitations.
Stickers are located on the ground for 6 feet spacing during visitation.
Staff member will supervise visitation to make sure everyone complies with regulations.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jasmine McCrory	TELEPHONE: (916) 214-5020
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2020

LIC809 (FAS) - (06/04)

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