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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 12:47:43 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, THE
FACILITY NUMBER:
392700366
ADMINISTRATOR:
SHERI KIMBRO
FACILITY TYPE:
740
ADDRESS:
2241 N UNION ROAD
TELEPHONE:
(209) 463-9100
CITY:
MANTECA
STATE:
CA
ZIP CODE:
95336
CAPACITY:
135
CENSUS:
96
DATE:
04/19/2024
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
03:00 PM
MET WITH:
Morgan Ware
TIME COMPLETED:
04:00 PM
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Unannounced Case Management 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 Special Incident Reports (SIRs) submitted from this facility in regards to resident care and supervision.
A review of the SIRs submitted was conducted in regards to multiple falls and frequency of falls with the facility designated Administrator and Resident Services Director at this time.
There were no deficiencies observed or cited during today's case management visit.
Exit Interview
SUPERVISOR'S NAME:
Liza King
TELEPHONE:
(650) 676-0442
LICENSING EVALUATOR NAME:
Charlie Yang
TELEPHONE:
(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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