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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002613
Report Date: 05/01/2024
Date Signed: 05/01/2024 11:46:42 AM


Document Has Been Signed on 05/01/2024 11:46 AM - 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 63DATE:
05/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Chantel GildeaTIME COMPLETED:
11:50 AM
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LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Executive Director Chantel Gildea.

This facility has a fire clearance for ninety-nine non-ambulatory residents. This facility has forty-eight assisted living apartments and twenty-four memory care apartments. The memory care unit has a delayed egress, medication room, laundry room, and common areas. The assisted living side has several common areas, offices for administration, laundry room residents may use, and the kitchen. There is an outside courtyard surrounded by the building.

Ten assisted living and eight memory care apartments were toured. No issues were found.

Several resident files and staff training records were reviewed.

Multiple topics were discussed.

No deficiencies cited.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2024
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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