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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005529
Report Date: 01/17/2023
Date Signed: 01/17/2023 12:15:57 PM


Document Has Been Signed on 01/17/2023 12:15 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:MEADOWS SENIOR LIVING, THEFACILITY NUMBER:
347005529
ADMINISTRATOR:NAVDEEP KUARFACILITY TYPE:
740
ADDRESS:9325 E STOCKTON BLVDTELEPHONE:
(916) 714-3755
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:160CENSUS: 68DATE:
01/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Alyssa SellersTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual inspection. LPA met with Executive Director (ED) Alyssa Sellers, and explained the purpose of the visit. The ED was conducting a new hire orientation and appointed facility maintenance director.

LPA and Maintenance Director toured the facility inside and out to ensure compliance of Title 22 regulations. LPA observed the first floor, the second floor, the activity room, dinning room, cinema room, elevator, and 6 random resident bedroom. The facility has an assisted living side and a memory care side with an outdoor garden area for each side. LPA observed the temperature inside the facility was measured at 74*F, which is within the required range of 68 degrees F and 85 degrees F. Resident rooms have their own thermostat, which residents are able to control. Resident rooms was sanitary and had the required furniture and furnishings. The hot water was measured in the rooms were 117*F - 119.0*F, which was within the regulatory range of 105 - 120 degrees F. LPA observed the centrally stored medications area, cleaning supplies, and sharps to be locked and inaccessible to clients. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguishers on all floors were observed to be in working condition with last check on 02/17/2022. All emergency exits were clear from obstructions. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. An emergency supply of food and water was observed. The facility is currently undergoing renovation of the floors. Although renovation is occurring, there are no obstructions of emergency exits and no sharps laying around. The facility has a plan in place to ensure resident's are not displaced and there are no disruption to services.

LPA requested updated copies of documentation: LIC 500 personnel report, LIC 610E Emergency Disaster Plan, Administrator Certificate, LIC 308, and Liability Insurance
No deficiencies were observed during today's visit. An exit interview was held, and a copy of the report was provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023
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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