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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000389
Report Date: 11/23/2021
Date Signed: 11/23/2021 11:37:03 AM

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 GARDENSFACILITY NUMBER:
347000389
ADMINISTRATOR:RIST, ALICIAFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:325CENSUS: 200DATE:
11/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Kimberly HagenTIME COMPLETED:
11:40 AM
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) Kevin Mknelly and Regional Manager (RM) Alycia Berryman, arrived at the facility unannounced on 11/23/2021 for a case management visit.. LPA met with Executive Director (ED) and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA completed a facility risk assessment upon arrival. LPA and RM ensured they used hand sanitizer just after entering the facility and the following Personal Protective Equipment (PPE) was worn. Additionally, LPA and RM were screened by receptionist.

The purpose for the visit was to discuss a recent eviction notification received by Community Care Licensing (CCL) for R1 and a recent fall by R2.

R1 has had a change of condition in their ability to manage a restricted health condition. ED informed LPA that they are successfully working with the resident, responsible parties, physician and home health to integrate measures to allow R1 to remain at the facility. LPA asked that the facility rescind the eviction order and copy CCL when the notice is sent.

R2 had a fall with injuries on 11/18/21 which was reported to CCL on 11/20/21. R2 has returned to the community and their care plan is being updated to meet R2's physical, cognitive and supervision needs.

LPA and RM were given a tour of the facility.
ED will email LPA a copy of staff schedules for 11/21/21- 11/27/21

As a result of this visit, there are no deficiencies cited.
Report was reviewed and copy provided
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
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