<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005529
Report Date: 08/18/2021
Date Signed: 08/18/2021 03:51:18 PM

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:BARBARA FLECKFACILITY TYPE:
740
ADDRESS:9325 E STOCKTON BLVDTELEPHONE:
(916) 714-3755
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:160CENSUS: 98DATE:
08/18/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:22 PM
MET WITH:Nisha KuarTIME 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 08/18/2021 at 3:22 PM, Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a Health and Safety Case Management Visit. LPA Valerio met with Health and Wellness Director Nisha Kuar and explained the purpose of the visit. LPA was screened for COVID-19 symptoms with temperature taken prior to being allowed entry into the facility.

On 08/17/21, the facility temporarily accepted 33 residents from their sister facility, Eagle Lake Village, due to an evacuation order in Lassen County. 10 residents are in the memory care side and 23 residents have moved in to the assisted living side.

LPA Valerio observed the memory care side and the assisted living side. Resident that were relocated to the facility had a cot, blankets, and pillows available for them in the rooms. Resident with a significant other were placed together in one room. According to Nisha, all medications have been audited and no residents are missing medications. The facility has a 30 day supply of PPE and enough food supply for the census. Donations have been given by Red Cross, Target, and Walmart.

LPA Valerio did not observe any health or safety risk to residents in care.Per California Code of Regulations, Title 22, there were no deficiencies observed or cited during today's Health and safety inspection. An exit interview was conducted and a copy of this report was left at the facility and given to Health and Wellness Director Navdeep Kuar.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1