<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202707
Report Date: 12/10/2020
Date Signed: 12/22/2020 09:42:01 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: 45DATE:
12/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Alton MendelsonTIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
licensing Program Analysts (LPA) Marybeth Donovan conducted a Technical Assist (TA) Visit via Zoom platform with Alton Mendelson Executive Director/Administrator, Sheryll Falcone HFEN and Jackie Jin to provide technical assistance to prevent and mitigate the spread of COVID 19 in the facility. LPAs conducted a virtual tour of the facility. LPA Donovan observed Donning and Doffing of PPE signage posted on the outside door of isolation room.

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

1. To place signage of the Doffing of PPE on the inside door of the isolation room(s).

2. Provide a trash can with a lid inside the isolation room for proper disposal of contaminated PPE. (CDC Guidelines)

3. To place signage of Contact and Respiratory Droplet Precaution-(PIN 20-07 ASC) in the isolation room(s).

4. Maintain hand soap in all bathroom and kitchen sink areas.

5. Review PIN 20-23 ASC and PIN 20-38 ASC for infection prevention and control.

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: 12/10/2020
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)
Page: 1 of 1