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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920108
Report Date: 09/18/2024
Date Signed: 09/18/2024 02:34:41 PM


Document Has Been Signed on 09/18/2024 02:34 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:OAKWOOD MEADOWS ASSISTED LIVINGFACILITY NUMBER:
345920108
ADMINISTRATOR:SUMMERHAYS, CALEBFACILITY TYPE:
740
ADDRESS:7241 CANELO HILLS DRTELEPHONE:
(916) 722-2800
CITY:CITUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:78CENSUS: 74DATE:
09/18/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Daniel Torgersen, Co-Administrator and Caleb Summerhays, Administrator TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada conducted a scheduled Pre-Licensing Inspection on 9/18/24 at 11:00 am. LPA met with Daniel Torgersen, Co-Administrator, Karen Padilla, Director of Nursing. Caleb Summerhays, Administrator, was present from 12:00 -2:00 pm. The reason for the pre-licensing is due to a change in ownership. There are (74) residents currently residing at the facility, (15) of whom are under hospice care. The facility is currently licensed for (78) bedridden residents, has a hospice waiver for (20) residents, and has separate Assisted Living and Memory Care units. All resident areas are on the first floor. The second floor is used for office and storage space.

LPA and Administrator toured the interior of the facility, including the common areas in both the Assisted Living and Memory Care units, the main kitchen, resident rooms, activity rooms, main laundry and outside patios. The facility was observed to be clean, in good repair and to have sufficient furniture and lighting throughout. There are (6) delayed egress doors throughout the facility with signs posted. Residents have a call button to use that is monitored on staff pagers and at the front desk. There are complete first aid kits in the medication rooms and the fire extinguishers were serviced on 5/28/24. Blankets/linens/supplies are kept in the laundry room. The hot water temperature is set at 120*F and measured within the required range of 105-120* in a resident bathroom and a main bathroom. Inside temperature measured 74*F. There is sufficient 7+day non-perishable and 2+day perishable supply of food, including fresh produce, and the freezer/refrigerator temperatures are set at required temperatures. Daily logs are maintained to ensure temperature controls are in compliance. The Ice machine is cleaned regularly. Activities are posted within each A/L and M/C unit. Vehicle maintenance records were reviewed along with resident and staff binders. All records were organized and contained current paperwork. Required posting are visible in the common area.

Comp III was conducted during today's inspection. Pre-licensing is complete and this facility has no deficiencies. LPA to notify analyst in application unit.
Exit interview. Copy of report provided to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
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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