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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004012
Report Date: 08/16/2023
Date Signed: 08/16/2023 03:59:47 PM


Document Has Been Signed on 08/16/2023 03:59 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:RIVER FOUNTAINS OF LODIFACILITY NUMBER:
397004012
ADMINISTRATOR:REBECCA COBBFACILITY TYPE:
740
ADDRESS:311 WEST TURNER ROADTELEPHONE:
(209) 334-3763
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:80CENSUS: 61DATE:
08/16/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rebecca Cobb, AdministratorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct a health and safety check on residents residing in the facility on 08/16/23 at approximately 9 am. LPA was met by Administrator Rebecca Cobb and Michelle Rodriguez, Care Coordinator and stated the purpose of the visit. LPA observed that the air conditioning was working in all areas of the facility except in the office area or the Group #1 section. The thermostat on the wall read 80 degrees Fahrenheit during this visit which is within the required range of 68-85*F. LPA interviewed resident #1 who was aware that the air conditioner was not working but who stated that she was not hot. LPA Campbell observed that the resident was wearing a fleece pullover. The forecast for today is up to 103 degrees*F in Lodi, CA during this visit.

LPA reviewed the plan of action with the Administrator for residents while the AC is not working. The Administrator stated that all residents who wanted a fan received one. The administrator used two swamp coolers and three air blowers to circulate air as observed by LPA Campbell. All eleven residents in the area had their doors open. Staff were checking on residents hourly and utilizing a hydration cart to provide constant liquids. LPA observed 1 caregiver checking on a resident during this visit. Administrator submitted an IR on the same day of the event.

In the event the facility loses power and no fans work, Care Coordinator Rodriguez stated residents are brought into the living room immediately. If any symptoms of heat exhaustion are not alleviated, arrangements with other residential facilities have been made to transport River Fountain residents to another facility if needed.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview held, copy of report given
SUPERVISOR'S NAME: Emerita CurielTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023
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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