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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700722
Report Date: 08/03/2023
Date Signed: 08/03/2023 03:53:36 PM


Document Has Been Signed on 08/03/2023 03:53 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:SIMON, CASEYFACILITY TYPE:
740
ADDRESS:8871 E STOCKTON BLVDTELEPHONE:
(916) 689-1000
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:170CENSUS: 58DATE:
08/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Casey Simon TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual inspection. LPA met with Administrator Casey Simon, and explained the purpose of the visit.

LPA toured the facility to ensure compliance with Title 22 regulations. LPA toured the Memory Care area with Memory Care Director Monica Cardenas. LPA observed the common areas, middle outdoor area, common restrooms, and resident bedrooms. LPA observed all areas to be clean, organized, and free from debris. Residents were observed in the common areas watching television, reading newspapers, relaxing outside, walking around, and having visits with loved ones. Staff were observed preparing activities and cleaning up after lunch. Resident bedrooms and bathrooms were fully furnished. LPA toured the Assisted Living area with Administrator Casey Simon. There are three floors that are accessible by stair or elevator. Elevators were in working condition with an updated inspection for this year. LPA observed a fire pull alarm system and fire extinguishers, all of which were in working condition. Resident bedrooms were furnished and clean. Bathrooms in common areas and private bedrooms were clean, fully stocked, and free from debris. Medications, cleaning supplies, and toxins were locked away. Facility temperature was 73.0*F throughout the facility. Exterior area of the facility was also inspected. There is a large patio with multiple seating areas, BBQ grill, fire pit, and pool area. The pool is surrounded by a fence that meets Title 22 regulations. No health and safety concerns observed. LPA observed dinning service, multiple activities being conducted, family visits, and an abundance of staff to resident positive interactions.

LPA reviewed 6 resident files. Resident files were up to date with current care plans. LPA reviewed 4 staff files, 2 from AL and 2 from MC. Staff files were current and annual training completed.LPA requested the following documentation be sent to LPA: LIC 500, Liability Insurance, LIC 610-D Emergency Disaster Plan

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, no deficiencies were observed. An exit interview was held, and a copy of the report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023
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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