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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390314809
Report Date: 09/30/2021
Date Signed: 09/30/2021 12:29:58 PM

Document Has Been Signed on 09/30/2021 12:29 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:O'CONNOR WOODS ASSISTED LIVINGFACILITY NUMBER:
390314809
ADMINISTRATOR:LEAL-MALLETE, PENNYFACILITY TYPE:
741
ADDRESS:3334 WAGNER HEIGHTS RDTELEPHONE:
(209) 956-3400
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 499CENSUS: 324DATE:
09/30/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Annette MontesTIME COMPLETED:
12:45 PM
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On 09/30/21 at 9:00am Licensing Program Analyst (LPA) Kevin Gould and CDPH Infection Preventionist Kristy Trausch arrived at O'Conner Woods Assisted Living for the purpose of conducting a healthcare associated infections (HAI) inspection. LPA and HAI met with staff, Annette Montes and together conducted a tour of the facility. The facility is a multi-building facility providing assisted living, memory care, skilled nursing and independent living. There are two memory care buildings, 1 skilled nursing building, 1 independent living building and two assisted living buildings.

LPA observed that screening for all visitors and residents is being conducted according to public health and CCLD recommendations. LPA observed all staff proving care in active COVID positive areas are wearing proper PPE including N95 masks and face shields. LPA observed plenty of hand sanitizing stations throughout the facility and buildings. Facility is documenting resident's temperatures daily. Facility is also utilizing other baseline measurements such a pulse oximeter to determine the need for additional care or hospitalization.

CDPH recommends improvements to housekeeping procedures and surface disinfecting. CHPD recommended discontinued used of diluted bleach solutions as a disinfectant and to use a disinfectant with a wet surface time of three minutes or less. CDPH also recommended that disinfectant bottles be labeled with their contents. LPA observe an abundant supply of PPE including N95 masks, face shields, gowns and gloves. LPA observed PPE carts ready for deployment and a trash can with lid placed inside COVID positive isolation rooms. Facility is utilizing rapid antigen tests and PCR testing for COVID in the facility.

LPA Gould observed the dining room in the independent living building and observed several large round tables with up to eight (8) place settings and chairs. LPA and CDPH recommended reducing capacity of the dining room by 50 percent with a maximum of 4 residents to the large round tables and no more than two residents to the smaller square tables.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2021
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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: O'CONNOR WOODS ASSISTED LIVING
FACILITY NUMBER: 390314809
VISIT DATE: 09/30/2021
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LPA was also informed that the church services are attended by all populations in the facility and mask wearing is required and they have not allowed singing at the chapel.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC809 (FAS) - (06/04)
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