<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 557005532
Report Date: 10/22/2021
Date Signed: 11/19/2021 03:25:02 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:SKYLINE PLACE SENIOR LIVINGFACILITY NUMBER:
557005532
ADMINISTRATOR:JACOB PRIMEAUFACILITY TYPE:
740
ADDRESS:12877 SYLVA LNTELEPHONE:
(209) 588-0373
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:135CENSUS: 100DATE:
10/22/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jacob Primeau, AdministratorTIME COMPLETED:
02:15 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 office meeting was conducted today in the Sacramento Regional Office via Microsoft Teams. The purpose of this meeting was to discuss ongoing low staffing at Skyline Place Senior Living, and Oak Terrace Memory care facility. Also, the possible temporary relocation of the residents to other Milestone Retirement Company owned facilities. Present at the meeting were Regional Manager (RM) Krystall Moore, Licensing Program Manager Stephenie Doub, Licensing Program Analyst(s) (LPA) Sarah Hurt, Caryl Ridgeway, Jacob Primeau facility Administrator, and Ginger Tarabochia, CEO Don Anderson, Paul Dendy, Mark Weister representatives of Milestone Retirement Company.

Issues Discussed during the meeting were:
· Ongoing facility staffing issues at Oak Terrace Memory care and Skyline Place Senior Living.
· Relocation of residents to other Milestone facilities
· Hiring process delays
· Recent COVID outbreaks at Oak Terrace Memory Care and Skyline Place Senior Senior Living.
· Recent HAI visit to Skyline Place Senior Living.


Continued on 809C...
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: SKYLINE PLACE SENIOR LIVING
FACILITY NUMBER: 557005532
VISIT DATE: 10/22/2021
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
26
27
28
29
30
31
32
Continued from 809..


The facility representatives discussed actions they have taken to secure staffing at both communities such as Job Fairs, bonuses and incentives. The corporation has allocated staff from other communities as well as Corporate personal to assist with staffing gaps. It was expressed that staffing agencies have been contacted, but they are not willing to provide serviced to the area. The RO provided staffing agency information for the facility to contact for possible staffing resource.

The licensee representatives agreed to submit the following for review by noon on 10/25/2021:
· a formal letter requesting to temporarily relocate residents to other Milestone facilities.
· an official plan detailing how the facility plans to ensure adequate staffing
· an updated LIC500, LIC308

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 representative Administrator Jacob Primeau 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 DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2