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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701040
Report Date: 04/23/2024
Date Signed: 05/01/2024 01:06:45 PM


Document Has Been Signed on 05/01/2024 01:06 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 138DATE:
04/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Eric HostetterTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with Administrator Eric, and explained the purpose of the visit.

LPA Valerio and Administrator Eric toured the facility to ensure compliance with Title 22 regulations. Upon entry, visitors enter the main lobby and sign in with front desk staff. Residents utilize the desk to sign in and out for any outings. Hand sanitizer was available for use at the front and throughout the facility.

LPA observed the common areas on the first floor, including the formal dinning area, cafe, bar/lounge area, library, and lobby seating areas, to be clean, free from debris, free from odors, and fully furnished. The memory care section of the facility has an entry key pad entry door. The facility delayed egress system was observed to be in working condition. Hot water was measured in a resident bathroom. The thermometer read 114.4 degrees Fahrenheit, which is within the regulatory range of 105.0 - 120.0 F. LPA observed three (3) staff and thirteen (13) residents. Residents were observed eating lunch or in their room during the time of the tour. Bedroom apartments were observed to be clean and free from odors. Sharps, cleaning supplies, and chemicals were observed to locked and inaccessible to residents in care. A first aid kit was observed in the medication room.

The facility has a large commercial kitchen that prepares made-to-order meals and snacks for residents. Areas of the kitchen were observed to be clean, organized, and free from pests. Servers and kitchen staff were observed to be utilizing safe food handling procedures. The refrigerator, freezer, and pantry areas were observed to have an adequate food supply. All appliances were observed to be in working condition.

LPA Valerio and Administrator Eric toured the Assisted Living/Independent areas of the facility. LPA observed resident apartments, which ranged from a studio, one bedroom, and one bedroom with a den. All bedrooms were observed to be clean and fully furnished.
Continues on LIC 809 - C...
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BRUCEVILLE POINT
FACILITY NUMBER: 342701040
VISIT DATE: 04/23/2024
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Continued from LIC 809

LPA Valerio and Administrator Eric observed the theater room, physical therapy room, activity/craft room, physical activity/gym room, salon area, staff break room, and medication rooms. All rooms were observed to have sharps or any other harmful devices to be locked away and inaccessible to residents. Hand sanitizer, water stations, and unisex restrooms were observed to be available for the residents throughout the facility. Medication room was observed to be locked when staff were not present. LPA Valerio observed medication technician staff pass medications, which was observed to be in compliance.

LPA observed staff to resident interactions. Interactions were observed to be engaging, positive, helpful, supportive, and friendly. Staff were observed assisting residents with meal service, greeting residents, assisting residents with multiple activities, cleaning the facility common areas, checking on the resident bedrooms, conducting medication pass, completing resident charting notes, assisting outside contractors with outdoor or indoor maintenance, and assisting with family or friend visits.

The facility has completed emergency drills. The last fire drill was conducted with AM, PM, and NOC staff on 03/18/24 and 04/12/24. A facility wide evacuation training was conducted on 04/12/24. Fire extinguishers located around the facility were observed to be fully charged with an annual maintenance date of 11/29/2023. Fire extinguishers, fire alarms, and carbon monoxide detectors are regularly monitored by maintenance staff. The facility has an emergency supplies readily available, if necessary.

LPA Valerio observed thirteen (13) resident files. Resident files were observed to be complete with updated assessments and resident information. Four (4) staff files were observed in addition to all staff in-service training. Staff files were observed to have up to date first aid certificates, training, fingerprint clearance, and necessary documentation.

Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, no deficiencies were observed during today's visit.

An exit interview was held, and a copy of this report was provided to Administrator Eric.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
LIC809 (FAS) - (06/04)
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