342700064-8-9-2024-27-AS-KVIA-D7Z2PP-20240809173440

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700064
Report Date: 08/09/2024
Date Signed: 08/09/2024 05:34:51 PM

Document Has Been Signed on 08/09/2024 05:34 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	GRAMERCY COURT		FACILITY NUMBER:	342700064
ADMINISTRATOR:	VERONICA MORALES		FACILITY TYPE:	740
ADDRESS:	2200 GRAMERCY DRIVE		TELEPHONE:	9164822200
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	85	CENSUS: 81	DATE:	08/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Veronica Morales		TIME COMPLETED:	05:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 08/09/24. LPA identified herself, explained the purpose of the visit, and asked to speak with Designated Facility Administrator (DFA). LPA met with Veronica Morales, the Residential Care For the Elderly (RCFE) Administrator. LPA observed that the Designated Facility Administrator's certificate, # 6002544735 expired on 05/05/26. LPA began by comparing the LIC 500 staff roster with the Guardian roster to ensure that all staff were appropriately cleared and that their background checks had been completed. All staff were in compliance at the time of inspection. LPA conducted a walkthrough of the facility. LPA inspected 3 resident rooms. All had the required furniture, furnishings and lighting to be in compliance at this time. LPA also observed 5 residents playing cards memory care. LPA noted soap, grab bars and non-skid surfaces in the showers. LPA measured the hot water and it was 107.3 degrees Fahrenheit and in compliance. LPA observed the fire extinguishers were last serviced on 01/03/24 Sentinel Fire Co. were also in compliance. The exterior of the facility was inspected by the LPA. There were no bodies of water present and the yard was completely fenced in. LPA observed that all screens and gutters were in good repair. There was 1 storage shed with a lock that contained yard equipment and storage items. There was also a covered patio area for residents to enjoy. LPA observed facility van taking 6 residents to Walmart. The LPA observed medication carts in the dining rooms of assisted living and memory care. LPA checked to ensure they were locked and medications were inaccessible to residents in care. LPA reviewed storage,

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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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Document Has Been Signed on 08/09/2024 05:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GRAMERCY COURT	FACILITY NUMBER: 342700064
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87463(a)

Reappraisals

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 3 resident files as they were missing current (re)appraisals which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/30/2024
	Plan of Correction
1 2 3 4	Administrator stated that an audit of the assisted living resdient files would be completed and submitted to kimberly.viarella@dss.ca.gov by 08/30/24. An audit of the memory care resient files will be submitted by 09/20/24.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GRAMERCY COURT	FACILITY NUMBER: 342700064
	VISIT DATE: 08/09/2024

NARRATIVE

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dosing, and destruction procedures. A review of the First Aid kit by the LPA found it to be complete and in compliance. LPA was informed that each medication cart had first aid items and each medication room had full first aid kits at the time of inspection.

A file review was completed by the LPA. 2 of 3 of the resident files reviewed were missing current LIC 602s (Physicians Reports) and updated care plans. Due to time constraints, this LPA reviewed 2 staff files and found them to be in compliance at the present time.

LPA interviewed 3 residents who stated they were happy at Gramercy Court, liked the food, and enjoyed the activities provided.

According to the California Code of Regulations, Title 22, the following deficiencies were observed and cited on the LIC 809 D page.

A copy of this report was provided along with APPEAL rights and an exit interview was conducted with the Designated Facility Administrator.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

LIC809 (FAS) - (06/04)

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