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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700366
Report Date: 04/19/2024
Date Signed: 04/22/2024 12:47:27 PM


Document Has Been Signed on 04/22/2024 12:47 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:COMMONS AT UNION RANCH, THEFACILITY NUMBER:
392700366
ADMINISTRATOR:SHERI KIMBROFACILITY TYPE:
740
ADDRESS:2241 N UNION ROADTELEPHONE:
(209) 463-9100
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:135CENSUS: 96DATE:
04/19/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Morgan WareTIME COMPLETED:
03:00 PM
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Unannounced Plan of Correction visit made out to this facility 04/19/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Morgan Ware who was briefly interviewed at this time.
Current census was 96 residents.
The purpose of this visit was to follow up on the most recent deficiencies that were observed and cited on the last complaint visit conducted on 03/21/2024:
  • Residents in all residential care facilities for the elderly shall have all of the following personal rights:
1) To be accorded dignity in their personal relationships with staff, residents, and other persons.

Proof of corrections were mailed into CCL for review by this LPA. Plan of correction letters were printed and copies were given to the facility designated Administrator at this time.

There were no further deficiencies observed or cited during today's Plan of Correction visit.

Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024
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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