A PREFERRED RESOURCE FOR LOCATING SENIOR CARE OPTIONS SINCE 1991


Facility Registration Form


New Residential Care Facilities


About Elder Carewill schedule an onsite evaluation visit with new residential care residences interested in an association with our company. 

Facilities in Sacramento, Placer, El Dorado, Yolo, Solano, Nevada and San Joaquin counties only should apply.

Interested facility administrators should complete this form and e-mail it to our offices.

INDICATIVE INFORMATION
(check all that apply)

Facility Name:

 

Contact Person:

 

Address:

 

City:

 

State: CA

 

Zip Code:

 

Telephone No.:

 

Cell phone No.:

 

Fax No.:

 

Email:

 

License No.:

 

Year Started:

 

Maximum No of Residents:

 

Number of Levels of Care:

 

Dementia Waiver:

 

Hospice Waiver:
 

 

Type of Facility  (check all that apply)

 

Independent Living Facility

 

Assisted living (large facility)

 

Small residential board and care home

 

Skilled nursing facility  

Accommodations   (check all that apply)

 

 Studio                  Private

 

 1 bedroom           Semi-private

 

  Two bedrooms   Private Bathrooms
 

Ambulation Status   (check all that apply)

 

Accept ambulatory clients only

 

Accept non-ambulatory clients

 

Accept clients in wheelchairs
 

Cognitive Status  (check all that apply)

 

Alzheimer's special care unit

 

Accept clients with Alzheimer's/dementia

 

Accept clients with Alzheimer's/dementia medium to late stages

 

Accept clients with mental disorders

 

Accept alcoholics
 

Services Offered   (check all that apply)

 

Bathing, dressing and grooming

 

Incontinence care

 

Diabetic diets

 

Short term feeding assistance

 

Medication management

 

Wheelchair transfer assistance

 

Night time assistance

 

Transportation services

 

Laundry and housekeeping  

 

Awake staff at night

 

Bed Ridden Waiver

 

Hospice Waiver

Special Needs   (check all that apply)

 

Oxygen

 

Urinary catheter

 

Ostomy care

 

Insulin injections

 

Wanderers

 

Accept smokers

 

Pets

Additional Information Regarding Your Facility:(Do not exceed 2000 characters)

 

Please mail us brochures, price lists and other information about your facility.

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1911 Douglas Blvd.,
Suite 85-198
Roseville, CA 95661
(Suburb of Sacramento)
Local:
(916) 783-8779
Email: info@eldercareservices.com
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