392700551-8-31-2021-27-AS-ABOE-C6ET6Q-20210831142731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 392700551
Report Date: 08/31/2021
Date Signed: 08/31/2021 02:27:33 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:	CAMLU ASSISTED LIVING		FACILITY NUMBER:	392700551
ADMINISTRATOR:	WHITTED, ALMA		FACILITY TYPE:	740
ADDRESS:	6037 N PERSHING AVE		TELEPHONE:	(209) 951-2030
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	96	CENSUS: 58	DATE:	08/31/2021
TYPE OF VISIT:	Case Management - Health Checks	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Alma Whitted		TIME COMPLETED:	02:45 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 8/31/2021 at 11am, Licensing Program Analyst (LPA) Ashley Boothe, arrived unannounced to conduct a conduct a Health and Safety Visit. Prior to today's visit LPA spoke with Administrator regarding facility risk assessment questions who stated no staff or clients have experienced symptoms of COVID within the last 10 days. LPA met with Administrator and explained the purpose of today’s inspection. Current Census is 58.

The purpose of the visit was to check on the temperature in the facility. Outside temperature measured at 82*F. LPA and Administrator measured the temperature in the common areas, dining room, hallways, offices and resident rooms within regulatory range, the lowest temperature was 68*F and the highest temperature was 80*F. The facility has 70 portable air conditioning units and several large portable cooling units in working order until the AC system is repaired/replaced. Temperatures were within regulatory range of 68*F to 85*F. Temperatures documented on log taken randomly throughout the facility and recorded and stored with facility records. No complaints from residents or staff have about the heat. LPA observed records to document no temperatures outside of regulatory range.

LPA observed COVID precautionary measures and signs for universal precautions are posted in common areas. Visitors and staff enter through designated point of entry and are screened by staff the facility. Administrator stated staff are using Cintas disinfectant with a 60 second sit time 2-3 times daily or in between use of tables in fireside or dining room. PPE on hand is at least 21 days supply including N95 respirators, gowns, gloves, hand sanitizer and face shields and Administrator will order additional supplies tomorrow. Administrator stated based on increased community spread, mass testing as many as are willing residents and unvaccinated staff weekly on Tuesdays. Communal dining and activities are not suspended and residents are encouraged to practice universal precautions of wearing a mask and social distancing.

Per the California Code of Regulations, Title 22, Division 6, no deficiencies observed or cited. Exit interview held, copy of report given.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 1