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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700368
Report Date: 05/17/2023
Date Signed: 05/18/2023 02:46:13 PM

Document Has Been Signed on 05/18/2023 02:46 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:COMMONS ON THORNTON, THEFACILITY NUMBER:
392700368
ADMINISTRATOR:ARBIOS, MARIEFACILITY TYPE:
740
ADDRESS:10711 THORNTON RDTELEPHONE:
(209) 476-1500
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 110CENSUS: 88DATE:
05/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:ARBIOS, MARIETIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by Executive Director. LPA explained the purpose of the visit to the Executive Director.

LPA Lewis inspected the physical plant including but not limited to the kitchen and food supply, dining room, several resident bedrooms, resident bathrooms, laundry area, living area, activities area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. The Memory Care area was also inspected. Facility is a 110 bed facility with a current census of 88. There are 64 residents in assisted living and 24 in the memory area. The entrance area and hallways have COVID precautions in place including social distancing noted. Toxins and medications noted to be locked to residents in care.


Hot water temperature was measured at 108 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils.

The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors.

LPA observed the facility to have adequate food supply of 7 days non-perishables and 2-days perishables in place supplied by Sysco Foods. Resident rooms were sanitary and had the required furniture.


LPA observed, fire extinguishers inspected on 3/7/2023 and current, smoke and carbon monoxide detectors. The first aid kit was found in compliance. Sprinkler and conveyance systems all in compliance.

Due to time restraints LPA will return at a later date to complete the annual inspection.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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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