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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000372
Report Date: 10/05/2020
Date Signed: 10/05/2020 04:43:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ATRIA DEL SOLFACILITY NUMBER:
306000372
ADMINISTRATOR:HARMON, TERESA LFACILITY TYPE:
740
ADDRESS:23792 MARGUERITE PKWYTELEPHONE:
(949) 458-1176
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY:120CENSUS: DATE:
10/05/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Terri HarmonTIME COMPLETED:
03:30 PM
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Licensing Program Manager (LPM) Alisa Ortiz, Licensing Program Manager Marina Stanic and Licensing Program Analyst (LPA) Joseph Alejandre contacted Executive Director (ED) Terri Harmon via telephone to commence a case management visit via telephone due to COVID-19 and pre-cautionary measures. LPM Ortiz identified herself and discussed the purpose of the call with Executive Director Terri Harmon. LPM Stanic and LPA Alejandre also participated in the call.

Executive Director (ED) Terri Harmon reported that since the Incident on 6/22/2020 (SIR report received by Agency on 6/22/2020) and case management visit on 7/6/2020 (See LIC 809 dated 7/6/2020 for more information) the facility has notified residents and private duty aid workers (caregivers hired directly by the resident they provide service for, not an employee of the facility) that they must provide information about the individual including identification and credentials to be allowed in the facility. All staff, supplemental workers (staff hired by the facility through an employment agency) and guests including private duty aid workers must enter through the main entrance only. The facility must be notified each time a private duty aid worker is going to see a resident. ED Terri Harmon reported that the companies contracted with the facility to provide supplemental workers are working with the facility to have files for the supplemental workers at the facility so qualifications can be verified. ED Terri Harmon stated that the facility is working to ensure the safety and security of all residents. The Facility has put measures in place and is working toward having more safeguards in place to protect the residents from possible theft from private duty aid workers or supplemental workers.

An exit interview was conducted with Executive Director via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2020
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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