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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577005341
Report Date: 06/23/2022
Date Signed: 06/23/2022 03:46:11 PM


Document Has Been Signed on 06/23/2022 03:46 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:CARLTON PLAZA OF DAVISFACILITY NUMBER:
577005341
ADMINISTRATOR:MIRIAM FARISFACILITY TYPE:
740
ADDRESS:2726 5TH STREETTELEPHONE:
(530) 564-7002
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY:150CENSUS: DATE:
06/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Genevieve Elder, Director of Resident ServicesTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an inspection and check in with facility regarding their hydration program for residents as well as the Infection Control Plan. Front Desk Staff are screening each and every visitor and staff as they enter the building. Information is logged.

Administrator Miriam Faris met LPA and discussed facility. There have been no new cases of Covid in several weeks. New staff in several departments are being trained. Administrator to update LIC200 for CCL.
According to Administrator, Infection Control Plan is being compiled. The facility's 6 nurses will be the Infection Control Preventionists and the Corporate Training Department will be a part of the Plan, as well.

LPA discussed hydration program in Memory Care with Memory Care Director Toni Jones. There are a variety of drinks available throughout the day to keep residents interested in drinking. At the time of visit, the list of drinks available included Horchata, Strawberry-Infused Water, and Lemon Water. MC Director remarked that the residents were all doing very well, with no recent falls or accidents.

There were no deficiencies at the time of this inspection.
No citations issued.

Exit interview conducted with Genevieve Eller, Director of Resident Services.
Copy of this report left with facility.


SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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