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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700722
Report Date: 09/23/2020
Date Signed: 09/23/2020 02:44:40 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:WELLQUEST OF ELK GROVEFACILITY NUMBER:
342700722
ADMINISTRATOR:MAUER, JENNIFERFACILITY TYPE:
740
ADDRESS:8871 E STOCKTON BLVDTELEPHONE:
(801) 815-0808
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:170CENSUS: DATE:
09/23/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:President Dean MattssonTIME COMPLETED:
03:00 PM
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Announced Pre-licensing visit was made by LPA Jason Lund via Facetime on 09/23/2020 with President Dean Mattsson, Executive Director Jennifer Mayer and Vice President of Operations Sophia Lukas, all with Wellquest Living Corporation.

The facility will be licensed to serve up to 170 residents at any given time. There were no residents in care during today's Pre-licensing visit.

Tour of the facility was conducted via Facetime. The facility has three floors with 133 rooms. 85 assisted living rooms all with private bathrooms and 48 memory care rooms with mostly shared bathrooms, with 6 of them having private bathrooms. There are two dining areas, salons, activity areas and medication rooms, one each for memory care and one for assisted living. The facility also has a wellness room, one other activity room for the assisted living side, laundry room and janitorial room.

A tour via Facetime was conducted of 1 assisted living resident room and 1 memory care resident room were observed and are in compliance at this time.

Kitchen area was toured by LPA Lund along with the Applicant’s via Facetime. There was a 2-day perishable and 7-day nonperishable quantities were viewed and are in compliance at this time.

The Facility has two Medication rooms that are locked were medication will be stored along with the first aid kits. Medication room contained all required components at this time. The facility has 43 fire extinguishers (EXP-9/21/21) placed throughout the 3 floors of the facility.

There were no deficiencies observed during today's Pre-licensing visit.
LPA Lund completed Component 111 requirements with the facility.

Report will be emailed for signature and emailed back to LPA Lund
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020
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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