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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700064
Report Date: 11/22/2021
Date Signed: 11/22/2021 12:17:33 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:GRAMERCY COURTFACILITY NUMBER:
342700064
ADMINISTRATOR:CYSEWSKI, TRISAFACILITY TYPE:
740
ADDRESS:2200 GRAMERCY DRIVETELEPHONE:
(916) 482-2200
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:85CENSUS: 66DATE:
11/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Trisa CysewskiTIME COMPLETED:
12:20 PM
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On November 22, 2021 at 11:00am Licensing Program Analyst (LPA) Chris Hopkins arrived at Gramercy Court and conducted an unannounced case management visit. LPA met with Administrator Trisa Cysewski and stated the purpose of this visit.

LPA inquired about visitation policy. The visitation policy consists of the following: screening at front desk prior to entry. If the visitor is vaccinated they are allowed to enter the residents room and visit in their room. Vaccinated visitors must show proof of their vaccination. If a visitor is unvaccinated they are asked to take a rapid test at the facility, if they refuse they can go take a rapid test elsewhere, and if they don't oblige to that, then they can only visit outside maintaining 6ft social distance. The facility visitation policy, which was sent to resident responsible parties does ask before visits they call 24 hours in advance to schedule the visit, and it states the visitation hours which are 8am- 7pm.

Visitors are able to visit more than once a day. For the visitors visiting more than once a day if there is a long gap in between visit times they must get their temperature rechecked. There are visitor signs posted at the front door. LPA observed the LIC 808 mitigation plan, in the visitor section it does state visitors will be screened, and the facility would like a 24 hour notice prior to coming.

LPA asked for copies of the following:
  • Visitor Policy sent to responsible parties
  • Residents responsible party contact information
  • Visitor log
  • Visitor Policy posted on front door

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were cited during this visit. An exit interview was held and a copy of this report was provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
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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