275202755-2-4-2021-26-AS-GDAS-BXX3HA-20210204171538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 275202755
Report Date: 02/04/2021
Date Signed: 02/04/2021 05:16:43 PM

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:	BROOKDALE SALINAS		FACILITY NUMBER:	275202755
ADMINISTRATOR:	CARTER, JOY		FACILITY TYPE:	740
ADDRESS:	290 REGENCY CIRCLE		TELEPHONE:	(831) 443-6467
CITY:	SALINAS	STATE: CA	ZIP CODE:	93906
CAPACITY:	83	CENSUS: 49	DATE:	02/04/2021
TYPE OF VISIT:	Case Management - COVID-19	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Joy Carter		TIME COMPLETED:	02:47 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 Analyst (LPA) Grace Davis conducted Technical Assistance (TA) Covid Case Management tele- Inspection via ZOOM. Due to COVID-19 preventive measures, facility visits have been suspended. LPA met with Administrator Joy Carter (ADM), Health and Wellness Director Karla Del Castillo (HWD) and also present is Health Facilities Evaluator Nurse (HFEN) Rebekah Bird Wohlgemuth. Mass testing was conducted on 01/25/2021 and 02/01/2021. ADM stated Monterey local public health was aware of the covid + case at the facility. At 1: 30 PM, LPA toured the facility with ADM, HWD and HFEN nurse. LPA observed COVID-19 posters in common areas and screening station with hand sanitizer, paper towel, and screening log sheet. The facility has common staff bathroom with hand washing signage, liquid hand soap, paper towels and trash bin. LPA observed direct care staff are wearing mask, face shield, gloves and gowns. ADM stated the dining room are not used and meals are served at the resident rooms. HFEN nurse recommended the following:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Grace Davis	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BROOKDALE SALINAS	FACILITY NUMBER: 275202755
	VISIT DATE: 02/04/2021

NARRATIVE

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1.Ensure all staff are trained in proper cleaning of face shields, N95 fitting procedure and donning/doffing.
2. Place DO NOT SIT signs, or X-MARK signs on couch and remove chairs to ensure 6 feet social distancing.
3.Used trans bin with pedals to eliminate touching.
4.Ensure all cleaning products are EPA approved.
5.Wait 24 hours before deep cleaning covid positive rooms .

No deficiencies cited during today's Tele Visit. Exit Interview conducted with ADM. A copy of this report is e-mailed to the facility for signature.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Grace Davis	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021

LIC809 (FAS) - (06/04)

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