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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701040
Report Date: 05/22/2025
Date Signed: 05/22/2025 01:25:16 PM

Document Has Been Signed on 05/22/2025 01:25 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BRUCEVILLE POINTFACILITY NUMBER:
342701040
ADMINISTRATOR/
DIRECTOR:		HOSTETTER, ERICFACILITY TYPE:
740
ADDRESS:9730 BACKER RANCH ROADTELEPHONE:
(916) 226-5300
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 200CENSUS: 150DATE:
05/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Eric HostetterTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 5/22/2025, Licensing Program Analysts Arvin Villanueva and Sommer Hayes (LPAs) arrived at this facility unannounced to conduct their required annual inspection visit. LPAs met with Executive Director/Administrator Eric Hostetter (AD) and stated the purpose of the visit. This facility is currently approved to retain/accept 10 hospice residents and fire cleared to retain/accept 10 bedridden residents in the first floor only.

The LPAs and ADM toured the facility to verify compliance with Title 22 regulations. The facility is a three-story building, with memory care located on the first floor. It has a capacity of 200 residents, serving independent living, assisted living and memory care. The LPAs inspected all three floors, activity rooms, dining rooms, theater room, salon, laundry room, elevator, stairwells and resident apartments/units. Second floor is where medication room is located, and medications were found to be securely stored, locked, and inaccessible to residents. 1 of 2 elevators was tested and found to be in good repair at this time. 1 of 4 stairwells were inspected and found to have evacuation chair. Per administrator, each stairwell is equipped with evacuation chair located in the third floor.

LPAs observed 10 resident apartments/units (5 in Assisted Living and 5 in Memory Care) and were spacious enough to accommodate personal furnishings, and all observed units were clean, sanitary, and in good repair. Each resident unit had a smoke and carbon monoxide detector. In the Independent/Assisted Living area, each unit is equipped with their own washer and dryer. Each memory care units is equipped with electronic monitoring systems installed on the ceiling to detect falls and notify staff. Memory care also has delayed egress doors. One of the delayed egress doors was tested and found to be operable at this time.

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NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BRUCEVILLE POINT
FACILITY NUMBER: 342701040
VISIT DATE: 05/22/2025
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The LPAs observed the kitchen area to be clean, sanitary and free of pests. The refrigerator, freezer, and pantry areas were observed to have an adequate food supply. Refrigerator and freezer were maintained within the regulatory temperature. The facility maintains a minimum of two days’ worth of perishable food and seven days’ worth of non-perishable food. All appliances were observed to be in working condition. The LPA reviewed the menu and activity calendar, and the Administrator confirmed that each resident is provided with a copy of both. During the visit, kitchen staff were preparing lunch.

The LPAs observed a shaded area in the courtyard with tables and chairs, and the outdoor activity area is secure for residents. The outdoor passageways, walkways, driveways, and steps were free from obstructions and hazards. The facility does have a water fountain but it is not in use at this time. The facility has a generator to utilize during power outage.

Water temperature in 2 resident units were measure between 114 and 115 degrees Fahrenheit. Room temperature in the hallways were measured between 72 and 73 degrees Fahrenheit.



Review of 10 resident files (R1 - R9) which include review of Admission Agreement, Medical Assessment, Needs and Services Plan, and Ambulatory Status. No issues were noted at this time.
LPAs did not conduct medication review during this visit. Facility does not manage resident cash resources at this time.

Review of 10 staff files (S1 - S9) which include review of background clearance, First Aid and/or CPR, Health Screen, Initial and Ongoing Training. Per interview and record review, med tech staff are required to have current CPR certificate. No issues were noted at this time.

Facility conducts quarterly disaster drill. Last drill was conducted on 5/21/25. Last fire inspection report was conducted on 3/7/24 to include tests on all manual pull stations and smoke detectors. Per report, test results passed. Facility has a dementia and infection control plan.

Administrator provided the following documents during this visit: current Liability Insurance Certificate, LIC500 and LIC308 to the Department.

No deficiencies are being cited at this time. Exit interview was conducted and a copy of this report were provided.

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NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC809 (FAS) - (06/04)
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