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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390314809
Report Date: 07/07/2021
Date Signed: 07/08/2021 07:16:57 AM

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:O'CONNOR WOODS ASSISTED LIVINGFACILITY NUMBER:
390314809
ADMINISTRATOR:LEAL-MALLETE, PENNYFACILITY TYPE:
741
ADDRESS:3334 WAGNER HEIGHTS RDTELEPHONE:
(209) 956-3400
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:499CENSUS: 425DATE:
07/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Dawn Shimel, AdministratorTIME COMPLETED:
12:45 PM
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On 07/072021 at 9:10 AM, Licensing Program Analyst (LPA) Bruce Jacobs met with Facility Administrator Dawn Shimel to conduct a required 1-year annual inspection. LPA also met with Executive Director Penny Leal-Mallete and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 499 residents. The facility has 325 residents in Independent Living, 72 in Assisted Living and 28 currently in memory care. The facility has submitted and is following their Mitigation Plan and the focus of this evaluation was on infection control procedures and processes.

LPA toured the facility including but not limited to apartments, bathrooms, kitchen, dining room areas, common area and courtyards. All outdoor and indoor passageways observed were kept free of obstructions. A comfortable temperature throughout the facility is maintained at 76 degrees Fahrenheit. LPA observed lighting in apartments are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid floors. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods.

Fire extinguishers were last serviced in April 2021 and are in compliance. A Fire Department inspection was completed on 12/17/20 and the facility passed the inspection. The inspection included tests on the alarms on egress doors, fire extinguishers, smoke detectors and alarm system. Emergency Disaster Plan was posted.,

Updated copies of the following documents as needed were requested for facility file and are to be submitted to CCLD by 08/7/2021: LIC 308 Designation of Administrative Responsibility, LIC 309 Administrative Organization, LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan

No deficiencies cited during inspection. Exit interview conducted with Administrator Dawn Shimel
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce JacobsTELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
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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