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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701306
Report Date: 08/13/2024
Date Signed: 08/13/2024 04:20:45 PM

Document Has Been Signed on 08/13/2024 04:20 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:MEADOWS SENIOR LIVING, THEFACILITY NUMBER:
342701306
ADMINISTRATOR/
DIRECTOR:		SELLERS, ALYSSAFACILITY TYPE:
740
ADDRESS:9325 EAST STOCKTON BLVD.TELEPHONE:
(916) 877-7835
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 160CENSUS: DATE:
08/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:38 PM
MET WITH:Alyssa SellersTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 8/13/24, at 2:38pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a case management visit regarding an incident report received by the Department on 6/26/24. LPA met with Alyssa Sellers, Executive Director (ED), and stated the purpose of the visit.

Incident Description: On 6/20/24, a resident in care (R1) reported to the care staff that they were being abused by their friend. R1 claimed that their friend was drugging them and attempting to kill them. R1 requested assistance to call 911 and to be transported to the hospital.

Actions Taken: R1 was promptly transported to the hospital for evaluation and treatment. The police were notified and conducted a visit to the facility. Adult Protective Services (APS) and the Ombudsman were also informed and initiated their investigations.

Hospital Findings: A drug test conducted at the hospital indicated the presence of opiates and fentanyl. These substances were consistent with R1’s current medications prescribed per hospice orders.

Follow-Up Actions: On 6/21/24, a hospice nurse conducted a follow-up visit to adjust R1’s medications. Review of R1’s medication list from 8/25/23, confirmed the use of a fentanyl patch. R1’s Needs and Services Plan dated 4/9/24, confirmed that R1 was under hospice care due to a malignant condition.

Progress and Final Outcome: Progress notes from 6/21/24, to 7/26/2024, documented ongoing hospice care and medication adjustments. R1 experienced increasing confusion due to the progression of their illness. R1 passed away on 726/24, during a hospice nurse visit.

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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MEADOWS SENIOR LIVING, THE
FACILITY NUMBER: 342701306
VISIT DATE: 08/13/2024
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Summary: The incident involving R1's report of abuse was thoroughly investigated by different agencies, and subsequent medical and administrative reviews confirmed that R1's medication use was appropriate as per hospice guidelines. The progression of R1’s condition and their eventual passing were consistent with the expected outcomes of their terminal illness and hospice care.

Per California Code of Regulations, Title 22 no deficiencies were observed or cited during today's case management inspection.



An exit interview was conducted with ED and Caryl Ridgeway, Management Company representive and a copy of this report was provided.





















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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
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