392700368-9-22-2021-27-AS-BJAS-C74S2Z-20210922133023

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 392700368
Report Date: 09/22/2021
Date Signed: 09/22/2021 01:30:29 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:	COMMONS ON THORNTON, THE		FACILITY NUMBER:	392700368
ADMINISTRATOR:	MILLER, CAROL		FACILITY TYPE:	740
ADDRESS:	10711 THORNTON RD		TELEPHONE:	(209) 476-1500
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	110	CENSUS: 100	DATE:	09/22/2021
TYPE OF VISIT:	Case Management - COVID-19	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Carol Miller, Administrator		TIME COMPLETED:	01:40 PM

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LPA Bruce Jacobs met CDPH HAI Hosniyeh Bagheri arrived at the facility for infection control training and mitigation. LPA and HAI met with Administrator Carol Miller. The census was 100, with 9 residents on hospice. Hosniyah provided information and instruction on isolating testing and infection control practices. Questions answered on the isolation of residents, testing and staffing concerns.. Also discussed were visitation requirement, Dining and activities are closed until the facility is cleared.

A tour of the facility was conducted. LPA observed physical plant was clean and in good repair. There is an exterior hand washing station where all staff and visitors enter the facility. PPE and the visitor's log were observed. Staff screen at the beginning and end of the shift. Soap, sanitizer, and paper towels were available at kitchen hand washing sink. Meals were served in rooms at this time. PPE and sanitizer was available throughout the facility. There is an entire room dedicated to PPE storage and regularly tracked inventory. Staff restroom was stocked with soap, sanitizer, paper towels. Employees are breaking in lobby and activities director is responsible to clean the tables in-between use. All residents live in individual apartments with restroom, kitchen, and living room.

Exit interview conducted and a copy of the reported provided to the Administrator.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce Jacobs	TELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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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