397003261-8-19-2021-27-AS-ADGA-C62W3F-20210819165551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 397003261
Report Date: 08/19/2021
Date Signed: 08/19/2021 04:55:59 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:	BROOKDALE TRACY		FACILITY NUMBER:	397003261
ADMINISTRATOR:	PAMELA BRADLEY		FACILITY TYPE:	740
ADDRESS:	355 W GRANT LINE RD		TELEPHONE:	(209) 835-1000
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	180	CENSUS:	DATE:	08/19/2021
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Sara Mackedsy Executive Director (ED)		TIME COMPLETED:	04:34 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	An Informal Conference was conducted today in the Sacramento Regional Office via Webex. The purpose of this informal conference meeting is to discuss the high volume of deficiencies/complaints/inability to remain in substantial compliance with the regulations/or specific incidents that has occurred within the last 2 years. Present in the meeting is Licensing Program Manager (LPM) Stephenie Doub, Licensing Program Analyst (LPA)Arlene Garcia, and Sara Mackedsy Executive Director (ED), Zachary Butcher District Director of Operations (DDO), and Kadijatu Barrie District Nurse (DN) of Brookdale Tracy. The informal conference process was explained during this meeting. The facility was licensed on 04/26/2006, may serve up to 180 residents age 60 and older. Fire Clearance allows 137 nonambulatory, 31 ambulatory and 12 bedridden. Hospice Waiver allows a maximum of 10 residents. Since licensure the facility has been cited 16 Type A violations which includes a substantiated complaint. Current Census Memory Care: 28 DDO stated facility has been through transition with management. Facility had been experiencing concerns and issues with previous ED. Currently, they facility is going through a process to recovery of rebuilding staffing and operational best practices. The facility brought in Interim Operational Manager, Pamela Bradley and Interim LVN, Sarah Archuleta Weaver while looking for newly appointed ED Sara Mackensey. 809 CONT. >>>>>>>>>>>>>>>>>>>>>>

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arlene D Garcia	TELEPHONE: 916-862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: BROOKDALE TRACY	FACILITY NUMBER: 397003261
	VISIT DATE: 08/19/2021

NARRATIVE

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LPM discussed following concerns: staffing, care and supervision. During investigation, management claimed facility was fully staffed and management was able to step in to support. Reviewing the incident reports show staff observe the incident but do not see the staff providing proactive care to prevent the incidents. ED stated facility has provided Clairbridge leadership training on Monday 8/16/21 and Tuesday 8/17/21 to provide support to the staff. ED stated the recruiting process is focusing on quality of care providers.

Other topics discussed were Security, NOC shift support, dining staff, building maintenance, and communication. ED stated they have extended concierge hours, provided additional phone to NOC shift to have on carts, have dining managers per shift, and rehired the Health & Wellness Director to work with MedTechs and NOC shift. DDO stated new cleaning procedures have been implemented and high traffic areas of carpet will be replaced. ED is providing constant communication to council, residents, and families through Town Halls, meetings, and phonecalls.

Licensee will provide LPA with copies of staff trainings for last 3 weeks and LIC 500 by EOD 8/20/2021.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was conducted with Sara Mackedsy Executive Director (ED) via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arlene D Garcia	TELEPHONE: 916-862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

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