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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001215
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:21:17 PM


Document Has Been Signed on 12/01/2023 03:21 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: 45DATE:
12/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Maria Rodriguez, RCFE Manager TIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Jill Nakagawa (JN) arrived unannounced on 12/01/2023 at University Retirement Community at Davis to conduct an Annual Inspection. The facility is a CCRC which is licensed for 500 residents.

LPA JN met with Maria Rodriguez, RCFE Manager and toured the facility, including Memory Care, Assisted Living, common areas, kitchen, outdoor recreation areas, library, auditorium, beauty salon, The Nook (a small store) and dining areas.

Assisted Living currently has 35 residents. Memory Care currently has 10 residents. All rooms were clean and a comfortable temperature. Room temperatures ranged from 69 -71 F. The upstairs dining room, which had been recently renovated was clean and decorated for the holidays. The kitchen was clean and sanitary, with an ample supply of perishable and non-perishable foods. All kitchen equipment was clean and safely stored.

Independent Living currently has 260 residents who live in the main building and also in cottages on the premises.

The Licensee has an approved dementia plan of operation. An 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 06/30/2023. Fire extinguishers were serviced on 02/15/23 and were fully charged.
Continued on 809-C.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 DAVIS
FACILITY NUMBER: 577001215
VISIT DATE: 12/01/2023
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Continued from 809

LPA requested the following documents by 12/15/2023:

LIC500
Resident Roster for AL and MC
Proof of Liability Insurance
LIC308

There were no deficiencies. No citations issued. Exit interview conducted with Christie Dewar, AL/MSU Resident Care Manager..
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
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