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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000389
Report Date: 03/24/2023
Date Signed: 03/24/2023 04:43:43 PM


Document Has Been Signed on 03/24/2023 04:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:ATRIA EL CAMINO GARDENSFACILITY NUMBER:
347000389
ADMINISTRATOR:KIMBERLY HAGENFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:325CENSUS: 178DATE:
03/24/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Kimberly Hagen, Executive DirectorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 3/24/2023 to conduct a Case Management Legal visit in accordance with the Stipulation and Order effective 6/1/2022-5/31/2024. A copy of the Stipulation and Order is available for review upon request. LPA met with the Executive Director, Kimberly Hagen.

During today's visit, LPA reviewed the following stipulations of the order:

1. Facility shall be clean and in good repair
-During inspection, LPA observed facility to be clean and in good repair

2. Alert button logs
-LPA observed documentation regarding alert button logs and observed that alert buttons were being responded to timely
-Facility is reporting regularly to LPA regarding response times for alert buttons

3. Audit of resident care tasks and staff numbers
- LPA observed records of resident care task audit and staff numbers and observed sufficient staff per resident care needs

4. Staff training
-Facility is conducting monthly training and LPA observed staff training material and attendance sheets

No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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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