390314809-1-4-2023-27-AS-MJEN-CMS2H4-20230104162408

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 390314809
Report Date: 01/04/2023
Date Signed: 01/04/2023 04:24:32 PM

Document Has Been Signed on 01/04/2023 04:24 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:	O'CONNOR WOODS ASSISTED LIVING		FACILITY NUMBER:	390314809
ADMINISTRATOR:	LEAL-MALLETE, PENNY		FACILITY TYPE:	741
ADDRESS:	3334 WAGNER HEIGHTS RD		TELEPHONE:	(209) 956-3400
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	499	CENSUS: 98	DATE:	01/04/2023
TYPE OF VISIT:	Case Management - Health Checks	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Penny Mallette		TIME COMPLETED:	04:30 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 1/4/23 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a health and safety check related to the 2023 Winter Storm. LPA Jensen met with Executive Director Penny Mallette and explained the purpose of today's visit. The facility is a Continuing Care Retirement Community with Independent Living, Assisted Living, Memory Care and Skilled Nursing. The Assisted Living unit currently has a census of 72 and the Memory Care Unit has a census of 26. A portion of the facility lost power on 12/31/22 and the power was restored in the late afternoon on 1/1/23. LPA Jensen observed a down tree on the grounds that appeared to have fallen away from the living units. The facility has generators that power the Assisted Living Unit/Memory Care and Skilled nursing units. These generators were in use for the outage in order to provide light and heat. The facility has a Public Announcement (PA) system that was used to communicate with residents. Portable generators are available for the Independent Living unit for use in the common areas. The units also have common gathering areas/recreation rooms that have gas fire places. Lanterns were used in the hallways of the Independent Living unit. All residents have emergency call pendents they can activate if they need assistance. The facility has not experienced staffing shortages and has contracts with staffing agencies if the need arises. The facility did loose a substantial food supply from the walk in refrigerator during the outage. The food supply that remained was supplemented by providing catered meals that included pizza and sandwiches until the food supply was replenished. LPA Jensen observed there to be 2 day supply of perishable food and a 7 day supply of non-perishable food on site. A large food order consisting mainly of proteins was delivered today and included steak, hamburgers, turkey, fish and frozen pastas. Continued on LIC 809C...

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 LIVING	FACILITY NUMBER: 390314809
	VISIT DATE: 01/04/2023

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While there was some fresh vegetables on hand, a large produce order is also scheduled to be delivered tomorrow. Food was delivered directly to resident rooms in Assisted Living during the outage and offered in the main dining hall for Independent Living. Residents in the independent living units had the option having their meal(s) delivered to their room upon request by using their pendents to call for staff.

No residents were sent out to emergency medical care during the outage. No residents using oxygen were affected by the outage as power was lost in only a portion of the community. The Executive director has established an emergency response team consisting of staff that will be present and follow an action plan in the event this current storm causes more challenges. A resident forum was held yesterday (1/3/23) to discuss any concerns residents had related to this recent storm. The facility has placed an order for shipment of battery operated emergency lights for use in the stair wells of the independent living unit. The facility is also making arrangements for the lease of a refrigerated truck to have as a contingency plan in case power is lost again. The LIC 610E was reviewed and is in compliance.

There are no health and safety concerns with the facility at this time.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

LIC809 (FAS) - (06/04)

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