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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001215
Report Date: 12/01/2022
Date Signed: 12/01/2022 12:00:45 PM


Document Has Been Signed on 12/01/2022 12:00 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



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: 294DATE:
12/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maria Burton, AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jill Nakagawa (JN) arrived unannounced on 12/01/2022 at University Retirement Community at Davis to conduct an Annual Inspection that focuses on Covid-19 Mitigation.

At arrival LPA JN was prompted to go through the automated screening process for Covid-19 exposure and symptoms and to sign in at the information desk where a visitor's badge was given. Hand sanitizer was available for use. LPA JN met with Administrator Maria Burton and toured the facility, including Memory Care, Assisted Living, common areas, 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 33 residents. 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 250 residents.
Facility has renovated and opened The Orchard dining area in the main building, allowing for more open dining and personal space. The facility was decorated for the Holidays with Christmas Trees and lights and other decor giving the place a cheery and homey feel.

The Licensee has an approved dementia plan of operation. The Mitigation plan was approved by the Department on 07/16/21, and the Infection Control Plan was submitted. Fire system is checked monthly by staff and an inspection of the Automatic Fire Sprinkler System was checked by independent fire protection company on 8/12/22. Multiple Fire Extinguishers were checked on 02/25/22 and were fully charged.

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: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022
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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