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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701040
Report Date: 04/20/2023
Date Signed: 04/25/2023 07:38:39 AM


Document Has Been Signed on 04/25/2023 07:38 AM - 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: 127DATE:
04/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Eric Hostetter - AdministratorTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPA's) Ruth Wallace and Pang Lee conducted unannounced Required 1 Year Annual Inspection Visit. LPA's met with Administrator and explained the purpose of the visit. Administrator Certificate # 6021870740 expires 01/03/2025. There is 1 hospice residents.

LPA's and administrator toured and inspected the physical plant inside and outside. There were no health and safety concerns. LPA's 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's observed required furniture and lighting throughout the facility. The hot water temperature was measured at 112.5*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.
LPA's 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's observed emergency food kits for 200 residents sufficient for 8 days. The first aid kits were available in the kitchen and medication rooms. LPA's observed the centrally stored medication areas to be locked and made inaccessible to the residents at this time. LPA's observed the fire extinguisher(s) expire 11/9/2023, smoke and carbon monoxide detector(s) in the facility were in good repair. Full Care Tool Inspection Completed at facility.

LPA's observed centrally stored medications, reviewed and compared resident medication vs. resident medication logs. LPA's requested 5 resident and 4 staff files for review. 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's 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 with administrator and a copy of report given.


SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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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