577001215-12-10-2024-21-AS-JNAA-DBTTD7-20241210133751

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 577001215
Report Date: 12/10/2024
Date Signed: 12/10/2024 01:38:01 PM

Document Has Been Signed on 12/10/2024 01:38 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 DAVIS		FACILITY NUMBER:	577001215
ADMINISTRATOR/ DIRECTOR:	MARIA BURTON		FACILITY TYPE:	741
ADDRESS:	1515 SHASTA DRIVE		TELEPHONE:	(530) 747-7000
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY: 500	TOTAL ENROLLED CHILDREN: 0	CENSUS: 48	DATE:	12/10/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:20 AM
MET WITH:	Maria Burton, Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:40 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	Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced on 12/10/2024 at University Retirement Community at Davis to conduct an Annual Inspection. The facility is a CCRC which is licensed for 500 residents. There are currently 48 residents residing in Assisted Living and Memory Care. LPA met with Maria Burton and toured the facility, including Memory Care, Assisted Living, common areas, kitchen, outdoor recreation areas, auditorium, beauty salon, The Nook (a small store) and dining areas. The facility is undergoing renovations and remodeling, so the entrance to the facility has been altered, but still safely accessible. Assisted Living currently has 35 residents. Memory Care currently has 13 residents. All rooms in Memory Care were clean and a comfortable temperature. Bedrooms were clean and appointed to highlight the personalities of the occupant. Room temperatures ranged from 71-74 degrees F. Six apartments in Assisted Living were inspected and found to be clean and well-maintained, with water temperatures measuring within regulation of 105-120 degrees F. Residents expressed that they were well-taken care of. The library and one of the downstairs dining areas was not in service due to the renovations. The upstairs dining room, was clean with tables set and ready for the upcoming dinner seating. 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, apartments and cottages on the premises. The Licensee has an approved dementia plan of operation and an Infection Control Plan. Fire system is checked monthly by staff and an inspection of the Automatic Fire Sprinkler System was checked by independent fire protection company on 06/25/2024. Fire extinguishers were serviced on 02/15/24 and were fully charged. Assisted Living and Memory Care conducted a Fire Drill on 11/27/2024. Elevators were inspected 04/10/24.

Kimberley Mota	TELEPHONE: (707) 588-5051
Jill Nakagawa	TELEPHONE: 707-588-5063
	DATE: 12/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: UNIVERSITY RETIREMENT COMMUNITY AT DAVIS	FACILITY NUMBER: 577001215
	VISIT DATE: 12/10/2024

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....

LPA reviewed the requirement that files must be available at all times. Administrator stated that CCL would have access through HR and IT with only momentary wait time while access was granted. LPA inspected 5 resident files and 5 staff files via the computer and found them to be complete, including residents' Care Plans and Staff training records.

LPA received a copy of the latest Certificate of Liability Insurance.

LPA requested an updated LIC500 for Assisted Living and Memory Care.

No deficiencies were found at the time of inspection.
No citations issued.

Exit interview conducted with Maria Burton, Administrator.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill Nakagawa	TELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2