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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275201799
Report Date: 10/04/2021
Date Signed: 10/07/2021 09:06:07 AM

Document Has Been Signed on 10/07/2021 09:06 AM - 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, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SOCIAL VOCATIONAL SERVICES,SALINAS #2FACILITY NUMBER:
275201799
ADMINISTRATOR:ELISABETH MARTINFACILITY TYPE:
775
ADDRESS:335 ABBOTT STREETTELEPHONE:
(831) 751-9145
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY: 90CENSUS: 11DATE:
10/04/2021
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Elisabeth MartinTIME COMPLETED:
01:33 PM
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Due to COVID-19 pandemic, Licensing Program Manager (LPM) Jackie Jin and Licensing Program Analyst (LPA) Yatfai Eric Ng, partnered with a Program Clinical Consulting Nurse Evaluator II (PCCNE) Lori Kopplinger from the Department, conducted a Case Management - COVID-19 - tele-visit via FaceTime, to provide a technical assistance to prevent and mitigate the spread of COVID-19 at the facility. LPM, LPA and, PCCNE met with the Program Director (PD) Elisabeth Martin.

The tour started at the outside of the entrance. Only 1 entry and exit point for the staff, clients, and visitors. A screening station with thermometer, hand sanitizer, and sign-in sheet were observed. There were signs reminding everyone to cover his cough at the entrance and throughout the facility. Hand sanitizers were readily available in different areas. All staff in the facility wore masks at all time. 2 Restrooms were toured. Soap, paper towels, and trash bins with covers were readily available. Hand washing signs were posted. There were indicating stickers on the floor in the activity rooms to inform clients where to sit to practice social distancing. Staff have staggered meal time and break time in different break rooms. Only 1 staff and 2 clients in an activity room at a given time. PD audits and orders PPE supply weekly. Screening procedure and isolation practice were reviewed with PD.

The following infection control practices were suggested:
  1. To review the Provider Information Notices PIN 21-40-ASC about the latest visitation guidance from the Department.
  2. To review the N-95 fit testing requirement from Cal/OSHA
  3. To review the usage of face shield when interacting with clients

PD stated the recommendations would be reviewed. No deficiency cited during visit. This report was emailed to PD to review and to obtain a signature.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Yatfai Ng
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2021
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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