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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202665
Report Date: 12/27/2023
Date Signed: 12/27/2023 03:21:16 PM


Document Has Been Signed on 12/27/2023 03:21 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:LOMA CLARA SENIOR LIVINGFACILITY NUMBER:
435202665
ADMINISTRATOR:JAIRUS CABUENAFACILITY TYPE:
740
ADDRESS:16515 BUTTERFIELD BLVDTELEPHONE:
(669) 258-3500
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:89CENSUS: 72DATE:
12/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Julie MayderTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - other visit. LPA met with Senior Resident Care Director (SRCD), Julie Mayder.

The purpose of the visit was to advise the facility of Title 22 regulations regarding Restricted Health Condition for Indwelling Urinary Catheters. During visit, LPA advised SRCD on the Title 22 regulations for Indwelling Urinary Catheters and the exception request process. LPA advised that the facility may retain residents with a restricted health condition as long as the resident meets the circumstances in the Title 22 regulations section 87623.

Based on interview, the facility currently has 1 resident (R1) who has an indwelling urinary catheter in Generations, also known as Memory Care. The resident had an exception request that has been approved by the Department in July 2023. The facility had another resident (R2) in Generations who had a temporary urinary catheter from 11/16/23 - 12/07/23. The Department did not receive an exception request for R2. LPA advised SRCD on going forward regarding the exception request process for restricted health conditions - indwelling urinary catheters. LPA advised the facility to reach out to the Department for any questions or concerns.

LPA advised to review Title 22 Regulation Sections 87616 - Exceptions for Health Conditions, 87612 - Restricted Health Conditions, and 87623 - Indwelling Urinary Catheter.

No deficiencies were cited per California Code of Regulations, Title 22. Advisory note provided. This report was reviewed with Senior Resident Care Director (SRCD), Julie Mayder and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/27/2023
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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