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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312763
Report Date: 01/25/2023
Date Signed: 01/25/2023 11:00:31 AM


Document Has Been Signed on 01/25/2023 11:00 AM - It Cannot Be Edited

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 TERRACEFACILITY NUMBER:
340312763
ADMINISTRATOR:MARY ERICKSONFACILITY TYPE:
740
ADDRESS:3865 J STREETTELEPHONE:
(916) 733-6510
CITY:SACRAMENTOSTATE: CAZIP CODE:
95816
CAPACITY:189CENSUS: 110DATE:
01/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mary EricksonTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 01/25/2023 at 9:45 AM. LPA Martinez met with Mary Erickson and stated the purpose of today’s visit. LPA inspected the physical plant of the facility to ensure compliance with Title 22 regulations.

The facility is licensed for 189 residents. 89 residents may be ambulatory and 100 residents may be non-ambulatory. There are currently 110 residents who reside at this facility. The facility has an approved hospice waiver. The hospice waiver is for 18 residents.

LPA Martinez toured the facility with Mary Erickson on 01/25/2023 at 10:00 AM.

The facility has one main Covid-19 screening entry point, and all visitors and staff are screened before entering the facility. Residents are allowed to have visitors in their apartments. In addition, the facility has a supply of PPE and has hand sanitizer throughout the facility. Moreover, social distancing practices are being implemented. The facility has spaced out the common facility furniture, and the facility is sanitary. The facility last fire inspection was on January 23, 2023, and the last fire drill was in December of 2022. The facility water temperature measured at 110 degrees. LPA Martinez reviewed resident and staff files, and files were up to date. In addition, the facility had an adequate food supply, and the facility has a water cooler dispensers throughout the facility.

The facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time.


An exit interview was held, and a copy of this report was given at the end of the visit.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
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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