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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202707
Report Date: 11/03/2020
Date Signed: 11/25/2020 11:03:23 AM

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:COTTAGES OF CARMELFACILITY NUMBER:
275202707
ADMINISTRATOR:RAGER, PATRICIAFACILITY TYPE:
740
ADDRESS:26245 CARMEL RANCHO BLVDTELEPHONE:
(831) 620-1800
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY:78CENSUS: 49DATE:
11/03/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Alton MendelsonTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) conducted a Tele-Visit via Zoom forum with Alton Mendelson Executive Director and California Department of Public Health HFEN Angela Brand to provide technical assistance to prevent and mitigate the spread of COVID 19 in the facility. LPA conducted a virtual tour of the facility.

During today's Tele-Visit, recommendations were made to as follows:

1. To place hand washing signs in the restrooms.

2. Conduct ongoing training on infection control guidelines and the use of PPEs.

Report reviewed with Alton Mendelson and a copy emailed for signature purposes.
SUPERVISOR'S NAME: George NwaforTELEPHONE: (650) 269-7419
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE:
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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