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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701306
Report Date: 01/09/2025
Date Signed: 01/09/2025 05:11:31 PM

Document Has Been Signed on 01/09/2025 05:11 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, THEFACILITY NUMBER:
342701306
ADMINISTRATOR/
DIRECTOR:		SELLERS, ALYSSAFACILITY TYPE:
740
ADDRESS:9325 EAST STOCKTON BLVD.TELEPHONE:
(916) 877-7835
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 160CENSUS: 88DATE:
01/09/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:01 PM
MET WITH:Alyssa SellersTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced Case Management - Annual Continuation visit today at this facility to continue with the annual inspection initiated on 12/10/2024. LPA met with Administrator/Executive Director, Alyssa Sellers, and stated the purpose of this visit.

LPA continued with facility visit to ensure facility is in compliance with Title 22 Regulations.

Review of 9 resident files (R1 - R9) which include review of Admission Agreement, Medical Assessment, Needs and Services Plan, and Ambulatory Status. LPA did not conduct medication review during this visit.

Review of 9 staff files (S1 - S9) which include review of background clearance, First Aid and/or CPR, Health Screen, Initial and Ongoing Training. It was noted that some staff completed their 1st aid training from Relias. At this time, LPA need to verify the validity of the training and may have to return for a case management visit.

Facility conducts quarterly disaster drill. Facility has a dementia and infection control plan. Advisory was provided to update their plan of operation, if necessary, to ensure compliance with the new dementia regulation.

Administrator provided the following documents during this visit: current Liability Insurance Certificate, LIC 610E, LIC500 and LIC308 to the Department.

No deficiencies are being cited at this time. Exit interview was conducted and a copy of this report were provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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