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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001215
Report Date: 12/09/2021
Date Signed: 12/09/2021 12:58:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:UNIVERSITY RETIREMENT COMMUNITY AT DAVISFACILITY NUMBER:
577001215
ADMINISTRATOR:MARIA BURTONFACILITY TYPE:
741
ADDRESS:1515 SHASTA DRIVETELEPHONE:
(530) 747-7000
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:500CENSUS: 47DATE:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maria Burton, AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA)Jill Nakagawa (JN) arrived unannounced on 12/09/2021 at University Retirement Community at Davis to conduct an Annual Inspection that focuses on Covid-19 Mitigation.

At arrival LPA JN was prompted to a table that was staffed to fill out a questionnaire regarding possible exposure/symptoms and have temperature read before being prompted to sign in at the information desk where a visitor's badge was given, noting the date of authorized visit. At this point, LPA met with Administrator Maria Burton, who toured the Assisted Living, Memory Care, kitchen, staff lounge and dining areas. There was adequate Covid-19 signage throughout the facility including the elevators, resident mail room, dining rooms, library, staff break room, and kitchens.

Assisted Living currently has 36 residents. Administrator and LPA toured multiple residents' rooms and found them all to be a comfortable temperature. The rooms inspected in Assisted Living were well-kept: kitchens cleaned and dishes put away, and bathrooms tidy and clean. Each resident had access to a mask and hand sanitizer. Memory Care currently has 11 residents. All rooms were clean and and a comfortable temperature. The dining room was clean and all kitchen equipment was securely stored. Independent Living has 256 residents.

Due to upcoming holidays, Facility has informed residents and families of the protocols in place for visits within and outside of the facility, and how to screen themselves for possible infections (either Covid-19 or other Upper respiratory infections). Facility has an approved dementia plan of operation. The Mitigation plan was approved by the Department on 07/16/21. Fire inspection was conducted by Davis Fire Department and approved on 5/28/2021.
There were no deficiencies.
No citations issued.
Exit interview conducted with the Administrator.









SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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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