347000389-11-4-2021-25-AS-KMKY-C89VCW-20211029161949

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347000389
Report Date: 10/29/2021
Date Signed: 11/04/2021 04:23:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME:	ATRIA EL CAMINO GARDENS		FACILITY NUMBER:	347000389
ADMINISTRATOR:	RIST, ALICIA		FACILITY TYPE:	740
ADDRESS:	2426 GARFIELD AVE		TELEPHONE:	(916) 488-5722
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	325	CENSUS: 206	DATE:	10/29/2021
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Aron Alexander		TIME COMPLETED:	02:20 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	*This report was amended* On October 29, 2021, a Non-Compliance Conference was conducted on this day in the Sacramento North Regional Office via Microsoft Teams, due to COVID 19 precautions. The purpose of this Non-Compliance Conference meeting was to discuss the history of citations that have been issued in the last year, related citations since 2016, complaints substantiated on August 6, 2021 and on April 8, 2020 and a civil penalty issued on August 30, 2021 in the amount of $15,000 dollars. Present in the meeting was Regional Manager (RM) Alycia Berryman, Licensing Program Manager (LPM) Maribeth Senty, Licensing Program Analyst (LPA) Angela Hood, Licensing Program Analyst (LPA) Kevin Mknelly, Senior Executive Director/ Administrator, Kimberly Hagen, Assistant Executive Director, Barbara Fleck, Facility Representative, Michael Mejia, Lori C. Ferguson, Jen Johnson and Aron Alexander, and Legal Counsel, Jay Thomas and Joel Goldman. The Non-Compliance Conference process was explained during this meeting to include the Administrative Process. Issues discussed during the meeting were: · Summary of Complaint filed against this facility · Summary of substantiated complaints filed since 2016 to present · Personnel Requirement violations · Criminal Clearance violation · Personal Rights of Residents in Privately Operated Facilities · Personal Rights violations · Administrator Qualifications and Duties/Accountability Report continued...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021

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, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: ATRIA EL CAMINO GARDENS	FACILITY NUMBER: 347000389
	VISIT DATE: 10/29/2021

NARRATIVE

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***This report was amended***
·Total overall A citations issued since 2016 to present: 8
· Total overall B citations issued since 2016 to present: 15
· Total overall citations issued during the 2021 year period noted include the following: Type A violations 1 Type B violations 3

The facility has stated they will do the following to achieve continued and substantial compliance:

Staffing is maintained with trained and competent staff sufficient to meet the identified needs of residents in care.

CCLD will do the following:
· Increase Monitoring

The Department would like the facility to submit the following by: November 5, 2021
It was agreed that the licensee will submit a compliance plan to the department by November 5, 2021. The plan will address resident care and staffing issues. Included in the plan will be a detailed description of oversight and quality assurance measures proposed for or in place at the facility that specifically review staff training and competency, call response times, resident tasks completion and resident care plans accuracy. Additionally, ensure the report includes data from December 2019 to present and information on the I-POD caretaker system.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit. An exit interview was conducted with Aron Alexander. A copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. Administrator/board member will sign the document and send signed copy to LPA, Kevin Mknelly at kevin.mknelly@dss.ca.gov

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021

LIC809 (FAS) - (06/04)

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