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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 03:53:03 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:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Casey Simon TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management visit. LPA met with Administrator Casey Simon, and explained the purpose of the visit.

LPA received notification that the licensee would like to incorporate a chicken coop in the garden area of the memory care unit. This area would be used as a form of activity of the residents and where the residents go to relax. Administrator stated the residents love the chickens and the chickens appear to be happy in their habitat. There is currently 2 chickens and a small chicken coop that is located in a corner area. LPA reviewed the plan to keep the area inaccessible when staff are not around and expected the chicken coop. According to the Memory Care Director, the chicken No health or safety issues observed.

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. 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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