342701306-1-9-2024-27-AS-AVIA-CZBW46-20240109155702

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701306
Report Date: 01/09/2024
Date Signed: 01/09/2024 03:57:14 PM

Document Has Been Signed on 01/09/2024 03:57 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:	MEADOWS SENIOR LIVING, THE		FACILITY NUMBER:	342701306
ADMINISTRATOR:	SELLERS, ALYSSA		FACILITY TYPE:	740
ADDRESS:	9325 EAST STOCKTON BLVD.		TELEPHONE:	(916) 877-7835
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	160	CENSUS: 89	DATE:	01/09/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Alyssa Sellers		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/9/2024, at 10:30am, Licensing Program Analyst (LPA), Arvin Villanueva arrived to conduct an announced inspection to the above facility for purpose of a pre-licensing evaluation. This pre-licensing is for Change of Ownership (CHOW). LPA met with the Administrator on record, Alyssa Sellers, and explained the purpose of the visit. LPA and the facility administrator toured the facility to ensure compliance of Title 22 regulation. LPA observed the first floor, second floor, the activity room, dining room, cinema room, elevator, and 10 random resident apartments/units. Facility has a 160-resident capacity for both assisted living and memory care residents. Currently, there are 89 residents in care, including the 13 residents living in the memory care area. Facility is a two-story building. Memory care is located on the first floor. Each floor has medication room. The resident apartments/units are spacious and will easily accommodate the client's furnishings. There is a shaded area in the yard with tables and chairs. Outdoor passageways, walkways, driveways, and steps are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Currently, LPA observe facility is undergoing cosmetic renovation inside, including new paints. Although renovation is occurring, there are no obstructions of emergency exits and no sharps and toxic material laying around and being left unattended. Bedrooms Residents: LPA inspected ten (10) resident apartments/units randomly, two (2) are from the memory care area. Facility is fire cleared for 6 ambulatory residents, 130 non-ambulatory residents, and 24 for bedridden residents. It is noted in the fire safety inspection that bedridden and non-ambulatory rooms are interchangeable in this facility. The selected apartments/units inspected were observed to be furnished with adequate storage for resident belongings. {Con't to LIC809-C}

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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: MEADOWS SENIOR LIVING, THE	FACILITY NUMBER: 342701306
	VISIT DATE: 01/09/2024

NARRATIVE

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{Con't from LIC809}

Bathroom: Each apartment/units contain private bathroom. All bathrooms inspected have working toilets, wash basins and full baths have showers. There are grab rails next to both the toilets and the showers as well as nonskid mats in showers. LPA observed adequate lighting in hallway leading to bathrooms via nightlights.

Toxins: Toxins are stored and locked at all times.

Water temperature: Water temperature in a randomly selected bathroom (in a resident apartment/unit) was measured at 119 degrees F.

Food Service and Kitchen: Kitchen area and dining area were inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are in locked and inaccessible to residents. Food supply was adequate and stored in kitchen refrigerator and walk-in pantry and consists of the following: A variety of fresh and canned fruit, vegetable and meat food items. Stove burners and oven observed to be in good repair.

Smoke Detectors: Each of the 10 residents’ apartment/unit were observed to have a smoke detector and carbon monoxide detectors. Smoke detectors are hardwired and interconnected, and they are fully operational.

Medications, First-Aid Kit & Book: First aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and manual which are stored in locked cabinet, available for staff use but inaccessible to clients.

Clients & Staff Files: Applicant will not be handling cash resources of residents. Records of staff and residents are stored in a locked room and accessible to staff.

{Con't to LIC809-C}

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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: MEADOWS SENIOR LIVING, THE	FACILITY NUMBER: 342701306
	VISIT DATE: 01/09/2024

NARRATIVE

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{Con't from LIC809-C}

Activities: Facility employs an activity director. LPA observed a living room on the first floor with a fireplace being installed. LPA observed residents doing activities in the activity area on the second floor. Outside activity area is properly enclosed with self-closing latches and all doors have auditory devices to monitor exits.

Pool/Jacuzzi & Pets: LPA did not observe bodies of water at the facility. LPA observed some residents have pets.

Component III: Conducted at the Pre-Licensing visit, on 1/9/2024 at The Meadows Senior Living, information provided about how to operate the facility within substantial compliance. LPA requested copies of the following documents: LIC 308, current liability insurance, current resident roster, and current staff roster.

An exit interview was conducted with Alyssa Sellers, and a copy of this report was provided. Accordingly, LPA Villanueva will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

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