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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700722
Report Date: 03/11/2022
Date Signed: 03/11/2022 02:33:23 PM


Document Has Been Signed on 03/11/2022 02:33 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:WELLQUEST OF ELK GROVEFACILITY NUMBER:
342700722
ADMINISTRATOR:MAURER, JENNIFERFACILITY TYPE:
740
ADDRESS:8871 E STOCKTON BLVDTELEPHONE:
(916) 689-1000
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:170CENSUS: 52DATE:
03/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jennifer Maurer TIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived at the facility unannounced to conduct a case management visit. LPA Valerio was screened for COVID-19 symptoms with temperature taken prior to being allowed entry. Front desk staff confirmed there are no staff or residents that have displayed any signs or symptoms of COVID-19 in the last 10 days.

LPA Valerio met with Administrator/Executive Director (ED) Jennifer Maurer to discuss incident reports sent to the department in December of 2021 regarding medications and another incident in December 2021 regarding two residents. ED explained the follow up that took place for both incidents in regards to staff and residents. Two staff were terminated as the result of an internal investigation for the medication incident. Based on information discussed, LPA Valerio did not observe any health or safety concerns and the facility is within compliance of Title 22 regulations.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was left for Executive Director Jennifer Maurer.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2022
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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