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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701040
Report Date: 04/18/2022
Date Signed: 04/18/2022 03:08:04 PM


Document Has Been Signed on 04/18/2022 03:08 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:BRUCEVILLE POINTFACILITY NUMBER:
342701040
ADMINISTRATOR:HOSTETTER, ERICFACILITY TYPE:
740
ADDRESS:9730 BACKER RANCH ROADTELEPHONE:
(916) 226-5300
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:200CENSUS: 88DATE:
04/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Eric Hostetter - AdministratorTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted 05/27/2021 unannounced 1 Year Annual Inspection Visit. LPA met with Administrator and explained the purpose of the visit. Administrator assisted with today’s visit. Administrator Certificate # 6021870740 expires 01/03/2023. There are 2 hospice residents.

The facility had COVID -19 posters and signs throughout the facility. The facility had a mitigation plan completed and approved on 5/27/2021. The facility had one central entry point, and the facility had routine symptom screening checks for residents, staff, and visitors. The facility had a symptom check binder for staff, residents, and care staff. Hand Hygiene procedures have been implemented.

LPA toured and inspected the physical plant inside and outside with administrator to ensure there were no health and safety concerns. LPA observed the lounge area, lobby, and common areas. In addition, the kitchen areas, dining area, and activity room was toured. The theater, art studio, and fitness room were reviewed to make sure that all components were functional and in good repair at this time.



A review was conducted of the apartment sizes and different layouts. Each unit has mini-split air and heating unit. Each unit has their own washer/dryer to help with infection control. Bipolar Ionization has been installed in Central heating, ventilation, and air condition (HVAC) system. Memory Care has 10 residents. The medication rooms, located primarily on the first floor, was toured. Kitchen pantry and walk-in freezer was toured for adequate food supplies and storage. LPA observed required furniture and lighting throughout the facility. The hot water temperature was measured at 111.9*F in resident apartment during this visit. Facility shall maintain the hot water temperature within the required range of 105-120*F. The temperature inside the facility measured at 73*F which was within the required range of 68-85*F.

Continued on 809-C
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2022
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: BRUCEVILLE POINT
FACILITY NUMBER: 342701040
VISIT DATE: 04/18/2022
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LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. LPA observed emergency food kits for 200 residents sufficient for 8 days. The first aid kits were available in the kitchen and medication rooms. LPA observed the centrally stored medication areas to be locked and made inaccessible to the residents at this time. LPA observed the fire extinguisher(s) expire 11/18/2022, smoke and carbon monoxide detector(s) in the facility were in good repair.

LPA observed centrally stored medications, reviewed and compared resident medication vs. resident medication logs. LPA requested resident and staff files for review. LPA reviewed (14) resident files and (10) staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no violations cited during this visit.

Exit interview held, copy of report given.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC809 (FAS) - (06/04)
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