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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803029
Report Date: 05/24/2021
Date Signed: 05/24/2021 04:36:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:AEGIS ASSISTED LIVING OF CORTE MADERAFACILITY NUMBER:
216803029
ADMINISTRATOR:KAUFMANN, LEE E.FACILITY TYPE:
740
ADDRESS:5555 PARADISE DRIVETELEPHONE:
(415) 927-4200
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:150CENSUS: 107DATE:
05/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator, Lee KaufmannTIME COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Sarangi and Fernandes-Goes arrived to conduct an annual inspection of Aegis Assisted Living of Corte Madera. LPAs toured the facility with Administrator, Lee Kaufmann.

Random rooms were inspected in the main assisted living area and random rooms in the two memory care units. Bathroom showers all have non-slip shower surfaces with grab bars. Bathroom have paper towel dispensers. Hot water temperature was at 111.3 degrees (which is within the acceptable temperature range). The memory unit has fenced outdoor patio assess for clients. The assisted living clients also have an outdoor patio courtyard. Egress doors from the memory units have audible alarms when doors are opened without access codes. The front door and main exits from the assisted living area also have audible Wanderguard system. The perishable and nonperishable food supply were well stocked, dining rooms and kitchen were inspected and well maintained. Menus and snack and beverages are available to clients and family. Activity schedules are posted. Facility has a theater, library and multiple indoor and outdoor sitting areas and a private dining area for clients and visiting families for special occasions.

Emergency disaster drills are conducted monthly during different shifts. Fire safety system including smoke detectors and carbon monoxide detectors are checked quarterly. Facility has PPE supply stored in the Administrator office at the facility. Staff have had all PPE training required on file and still working towards acquiring N-95 fit testing.

In addition, LPAs advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Disaster Drills conducted on March 3, 2021.

No deficiencies observed or cited during today's Required 1- Year inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
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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