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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700722
Report Date: 08/31/2022
Date Signed: 08/31/2022 03:01:32 PM


Document Has Been Signed on 08/31/2022 03:01 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: 66DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Jennifer MaurerTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Jamie Ivey Canady arrived unannounced to conduct a Required - Annual visit on 8/31/2022 at 12:00pm and met with Administrator Jennifer Maurer and explained the reason for the visit.

Administrator Certificate assigned to Christina L Garcia expires 8/12/2023. Christina is assigned as alternate Administrator. The facility is licensed for 170 non ambulatory of which 20 may be bedridden. There is a hospice waiver for 25 and delayed egress approved for the memory care area. Ambulatory residents are approved for all floors.

LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed an active community with residents engaging in activities in the library and having planned meals.

LPA observed 2-day perishables and 7-day non-perishables. LPA observed 2 personnel files and 2 resident files.

The temperature inside the facility was observed to be at 75*F which is within the required range of 68-85*F. The hot water temperature was measured at 119.3*F which is within the required range of 105-120*F. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility.

LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.
Cont on 809-C
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-CanadyTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 GROVE
FACILITY NUMBER: 342700722
VISIT DATE: 08/31/2022
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Upon a file review the following items were discussed to be submitted with any changes annually to facility LPA:

Designation of Facility Responsibility (LIC308)
Control of Property
Liability Insurance
Administrator Certificate-Updated
Personnel Report (LIC500)

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-CanadyTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC809 (FAS) - (06/04)
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