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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002613
Report Date: 05/15/2023
Date Signed: 05/15/2023 05:49:23 PM


Document Has Been Signed on 05/15/2023 05:49 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 NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:SUMMERFIELD SENIOR LIVINGFACILITY NUMBER:
515002613
ADMINISTRATOR:GILDEA, CHANTELFACILITY TYPE:
740
ADDRESS:1224 PLUMAS STREETTELEPHONE:
(530) 755-3850
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:99CENSUS: 59DATE:
05/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Chantel Gildea, Executive DirectorTIME COMPLETED:
02:30 PM
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On 5/15/2023 LPA Tryon visited the facility to conduct an annual visit. LPA met with Executive Director Chantel Gildea. The current census of the facility is 59 residents.
LPA toured the facility with Ms. Gildea including common areas, kitchen, dining room, food storage areas. Kitchen appeared clean and well-furnished. Food supplies appeared appropriate to meet the requirement of 2 days perishable and 7 days non-perishable supplies. Food appeared appetizing and well-balanced, was stored appropriately, etc.
LPA toured at least 6 resident apartments. Units were appropriately furnished with required furniture, were clean and picked-up. Bathrooms have non-skid mats, handrails, plumbing is in good condition and functioning. Facility is equipped with fire alarm system that is checked on schedule, carbon monoxide detectors, sprinklers. Fire extinguishers are present and charged. Memory care unit has delayed egress.
Facility is clean and appropriately furnished overall.
LPA reviewed 5 staff files and 6 resident files. Appropriate documentation is present and up to date.
LPA interviewed 2 available staff. LPA not able to interview residents as none were available at the time due to afternoon naps and activity taking place.

Administrator has appropriate qualifications. Admin. has submitted training to CCL to renew Admin. Certificate and is waiting for CCL to send new certificate.

The facility appears to be in substantial compliance with the regulations at this time. No deficiencies were cited at this visit.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023
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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